MedicaidAdministrativeHigh impact
Balance Billing of Emergency Room Services
Maryland Medicaid·MD · Emergency Medicine·Hospital
Effective date
Jun 30, 2000
We identified it
Jun 20, 2026
Summary
Maryland hospitals cannot balance bill Medicaid patients enrolled in managed care for emergency room services, even when the MCO denies the claim as non-emergency. Balance billing is only permitted when the patient knowingly consents in writing to receive non-emergency services without proper authorization.
Action Required
Immediately: Billing team must stop balance billing Medicaid managed care patients for emergency room services denied by MCOs as non-emergency. For non-emergency situations, obtain signed consent forms from patients clearly stating they understand they are on Medical Assistance and are choosing to receive services without MCO authorization. Update billing workflows to identify Medicaid managed care patients and flag emergency services for proper handling.