Ch. 499

1995 LAWS OF MARYLAND

(3) SEND THE RESULTS OF THE ANNUAL PATIENT SURVEY TO THE
SECRETARY OF HEALTH AND MENTAL HYGIENE, THE SENATE FINANCE
COMMITTEE, THE HOUSE ECONOMIC MATTERS COMMITTEE, AND THE HOUSE
ENVIRONMENTAL MATTERS COMMITTEE.

19-1507.

[(h) (1) If a physician's bill or request for payment for a physician's services
includes a charge to a patient for a diagnostic test for which payment may be made by a
payor, the amount payable with respect to the test shall be determined as follows:

(i) If the bill or request for payment indicates that the physician who
submitted the bill, or for whose services the request for payment was made, personally
performed or supervised the performance of the test or that another physician with whom
the physician shares the practice personally performed or supervised the test, the
payment shall be the reasonable charge for the test less the applicable deductible and
coinsurance amounts; or

(ii) If the bill or request for payment indicates that the test was
performed by another provider or an office facility, identifies the provider or office
facility, and indicates the amount the provider or office facility charged the physician who
submitted the bill or for whose services the request for payment was made, payment for
the test shall be the lower of:

1. The provider's or office facility's usual, customary and
reasonable charge for the test; or

2. The amount the provider or office facility charged the
physician for the test, plus a fee not to exceed $5, where the physician bills for such a
service, to cover the physician's costs in collecting and handling the sample on which the
test was performed less the applicable deductible and coinsurance amounts.

(2)     A payor may refuse payment of a bill, if the bill or request for a
payment:

(i) As provided under paragraph (1)(ii)1 of this subsection, does not
indicate who performed the test; or

(ii) As provided under paragraph (1)(ii)2 of this subsection, indicates
that the test was performed by a provider or office facility but does not identify the
provider or office facility or include the amount charged by the provider or office facility.

(3)     A physician may not bill:

(i) For any amount:

1. Other than the payment amount specified under paragraph
(1) of this subsection;

2. Other than any applicable deductible and coinsurance for a
diagnostic test for which payment is made pursuant to paragraph (1)(i) of this section;
and

- 2886 -