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PARRIS N. GLENDENING, Governor Ch. 64
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(i) The relative complexity of the health care service compared to
that of other health care services;
(ii) The cognitive skills associated with the health care service;
(iii) The time and effort that are necessary to provide the health
care service; and
(iv) Any other factors deemed appropriate by the Commission.
(4) Except as provided under subsection (d) of this section, a conversion
modifier shall be:
(i) A payor's standard for reimbursement;
(ii) A health care practitioner's standard for reimbursement; or
(iii) Arrangements agreed upon between a payor and a health care
practitioner.
(d) (1) (i) The Commission may make an effort, through voluntary and
cooperative arrangements between the Commission and the appropriate health care
practitioner specialty group, to bring that health care practitioner specialty group
into compliance with the health care cost goals of the Commission if the Commission
determines that:
1. Certain health care services are significantly contributing
to unreasonable increases in the overall volume and cost of health care services;
2. Health care practitioners in a specialty area have attained
unreasonable levels of reimbursable services under a specific code in comparison to
health care practitioners in another specialty area for the same code;
3. Health care practitioners in a specialty area have attained
unreasonable levels of reimbursement, in terms of total compensation, in comparison
to health care practitioners in another specialty area;
4. There are significant increases in the cost of providing
health care services; or
5. Costs in a particular health care specialty vary
significantly from the health care cost annual adjustment goal established under
subsection (f) of this section.
(ii) If the Commission determines that voluntary and cooperative
efforts between the Commission and appropriate health care practitioners have been
unsuccessful in bringing the appropriate health care practitioners into compliance
with the health care cost goals of the Commission, the Commission may adjust the
conversion modifier.
(2) If the Commission adjusts the conversion modifier under this
subsection for a particular specialty group, a health care practitioner in that specialty
group may not be reimbursed more than an amount equal to the amount determined
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- 591 -
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