Traditional MedicareReimbursementHigh impact
Billing for Medicare Part A Coinsurance for Dates of Service Effective 07/01/2005
Maryland Medicaid·MD · Geriatrics·Nursing Home
Effective date
Jul 1, 2005
We identified it
Jun 20, 2026
Summary
Maryland Medicaid changed how it reimburses Medicare Part A coinsurance for nursing home days 21-100, effective July 1, 2005. Providers must now use different billing methods (electronic vs paper) based on whether Medicare's payment exceeds $187.05 per day, and attach coinsurance worksheets for paper claims.
Action Required
Immediately: Nursing home billing staff must implement new Medicare Part A coinsurance billing process. For coinsurance days where Medicare pays $187.05+ per day, bill electronically using revenue code 0101 at $114/day (expect $0 payment). For days where Medicare pays less than $187.05, submit paper UB-92 claims with coinsurance worksheet and Medicare EOB attached. Email hiltners@dhmh.state.md.us to obtain required coinsurance worksheet. Update billing workflows to separate coinsurance days from regular Medicaid days on different claims.