Is There a Time Limit on When a Medical Provider Can Seek Payment?

Within the last few years, the answer is yes. In October 2017, the Maryland legislature established a one-year bill submission period for Maryland medical providers. Previously, there was no submission period outlined by state statute. The Maryland General Assembly amended § 9-660 of the Workers’ Compensation Act to add time restraints for providers seeking payment of medical bills for treatment related to an employee’s work-related injury. Specifically, the code under section (d) states that a provider who provides medical service or treatment to a covered employee shall submit to the employer or the employer’s insurer a bill for the service within 12 months from the later of the date that:

1) the medical service was provided;

2) the employer or insurer accepted the claim for compensation; or

3) the claim for compensation was determined to be compensable by the Workers’ Compensation Commission. Md. Lab. & Empl. Code Ann. § 9-660(d).

Providers have more leniency with timely submission than the payers of the medical bills generally. Maryland regulation COMAR 14.09.08.06 requires insurers to reimburse providers or to deny in full or in part or within 45 days of receipt of the provider’s bill.

Does that mean the insurer is completely off the hook if the provider submits nothing within that 12-month period?   As we know, nothing in the law is that black and white. The statute goes on to state that the employer or insurer may not be required to pay a bill that was submitted after the 12 months outlined above unless the provider files an application for payment within the Commission (also known as the C-51) within three years of the later:

(1) the date of the medical treatment or service;

(2) the date the employee’s claim was accepted by the employer or the insurer; or

(3) the date the employee’s workers’ compensation claim was found to be compensable by the Commission; and

The Commission excuses the untimely submission for good cause. Id. At this point, the Commission decides what constitutes “good cause” on a case-by-case basis. The statute is still considered to be new; we can anticipate in the future that we will have a clearer definition as to what instances will establish good cause as required by the Act.

Written by associate Stephanie Broznowicz.