reimbursement or attempt in any manner to retroactively collect reimbursement
already paid to a health care provider by reducing reimbursements currently owed to
the health care provider, withholding future reimbursement, or in any other manner
affecting the future reimbursement to the health care provider.

(d) (1) The provisions of subsection (b)(1) of this section do not apply if:

(I) a carrier retroactively denies reimbursement to a health care
provider because the information submitted to the carrier was fraudulent or
improperly coded; AND

(II) IN THE CASE OF IMPROPER CODING, THE CARRIER HAS
PROVIDED TO THE HEALTH CARE PROVIDER SUFFICIENT INFORMATION REGARDING
THE CODING GUIDELINES USED BY THE CARRIER AT LEAST 30 DAYS PRIOR TO THE
DATE THE SERVICES SUBJECT TO THE RETROACTIVE DENIAL WERE RENDERED.

(2) INFORMATION SUBMITTED TO THE CARRIER MAY BE CONSIDERED
TO BE IMPROPERLY CODED UNDER PARAGRAPH (1) OF THIS SUBSECTION IF THE
INFORMATION SUBMITTED TO THE CARRIER BY THE HEALTH-CARE PROVIDER:

(I) USES CODES THAT DO NOT CONFORM WITH THE CODING
GUIDELINES USED BY THE CARRIER APPLICABLE AS OF THE DATE THE SERVICE OR
SERVICES WERE RENDERED; OR

(II) DOES NOT OTHERWISE CONFORM WITH THE CONTRACTUAL
OBLIGATIONS OF THE HEALTH CARE PROVIDER TO THE CARRIER APPLICABLE AS OF
THE DATE THE SERVICE OR SERVICES WERE RENDERED.

(e) If a carrier retroactively denies reimbursement for services as a result of
coordination of benefits under provisions of subsection (b)(l)(i) of this section, the
health care provider shall have 6 months from the date of denial, unless a carrier
permits a longer time period, to submit a claim for reimbursement for the service to
the carrier, Maryland Medical Assistance Program, or Medicare Program responsible
for payment.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to a
retroactive denial based on improper coding issued on or after January 1, 2000,
regardless of the date of the service subject to the retroactive denial.

SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take
effect October 1, 1999 January 1, 2000.

Approved April 27, 1999.