Physical Therapy Billing in Maryland

Yes. Medicaid runs as HealthChoice, delivered largely through commercial managed care plans. So most Maryland Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.

Novitas Solutions (JL). That contractor adjudicates Medicare claims for Maryland providers, publishes the local coverage determinations that bind you, and hears the first level of appeal. An argument that works with them works across every state they cover.

The specialty causes first: unit counts that do not match documented treatment time; visit caps reached without notice; provider did not re-certify the plan of care in time. On top of those, Maryland Medicaid runs through commercial plans, so filing windows and authorization rules vary by plan rather than by program.

Maryland is a tort state for auto injuries, so standard coordination of benefits applies rather than an auto carrier taking first position. The injury still has to be identified at registration, because liability coverage may be primary for the related care.

A percentage of collections, banded by practice size, with a monthly minimum so a smaller practice is served properly rather than quoted a rate that does not cover the work. The Maryland rate card is on the state page.

Yes. All coding is performed by certified coders credentialed through the AAPC or AHIMA, working from the documentation you provide. Timed treatment codes, where unit calculation is systematic rather than occasional — an error repeats on every visit.