MedicaidReimbursementHigh impact
Region Realignment; Fiscal Year 2020 Rates for Nursing Facility Services
Maryland Medicaid·MD · Geriatrics·Provider Transmittal
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
This policy establishes revised reimbursement rates for nursing facility services under Maryland Medicaid effective July 1, 2019, with a region realignment for Fiscal Year 2020. The coinsurance worksheet provided shows specific daily rates ($170.50 per day for 2019 services) and billing instructions for Medicare coinsurance days using revenue code 0101 on UB-04 claims. Billing teams must use the correct daily rate and attach the completed worksheet to paper claims or bill electronically as indicated.
Action Required
By January 1, 2020: Billing team must update nursing facility billing system with revised coinsurance rates and ensure all claims for dates of service 7/1/2019-12/31/2019 use the coinsurance rate of $170.50 per day for revenue code 0101. Attach completed coinsurance worksheet (page 2 of 3) to all paper UB-04 claims, or bill electronically with the full amount calculated as number of coinsurance days × $170.50. Ensure Medicare EOB/remittance is attached to worksheet. Beginning 1/1/2020, a revised worksheet with updated Medicare coinsurance amounts must be obtained and implemented. Failure to use correct rates and attach required documentation will result in claim denials and payment delays.