Filing Nursing Facility Claims
Nursing facilities began filing claims through the Internet at www.emomed.com in October 2003. You must use www.emomed.com in order to transmit MO HealthNet claims in a Health Insurance Portability and Accountability (HIPAA) compliant manner. To apply for a user account for emomed.com, you may access the Application for MO HealthNet Internet Access Account at http://manuals.momed.com/Application.html and click on the Apply for Internet access link.
To assist nursing facilities with Internet billing the MO HealthNet has developed a set of Frequently Asked Questions.
- What are the revenue codes to be used when billing nursing home claims to MO HealthNet?
Valid codes are shown in the chart below.
Revenue Code The valid values are: 0110 Room - Board/Pvt 0119 Other/Pvt 0120 Room – Board/Semi 0129 Other/2 Bed 0190 Sub–acute 0191 Sub–acute/Level I 0192 Sub–acute/Level II 0193 Sub–acute/Level III 0194 Sub–acute/Level IV 0199 Sub–acute/Other 0180 General Classification 0182 Patient Convenience 0183 Therapeutic Leave 0184 ICF/MR – Any Reason 0185 Nursing Home (for Hospitalization) 0189 Other Leave of Absence
- How do I know which revenue code to use?
For residents receiving non–skilled nursing care, providers most frequently bill revenue code 0120, room–board/semi-private. Revenue codes 0110–0129 are non–skilled nursing service. Billing revenue codes 0190–0199 indicate residents are receiving skilled nursing services. The per diem to the nursing home is the same regardless if a non–skilled or skilled revenue code is billed. All revenue code descriptions may be found by accessing the “Help” feature under the Nursing Home Management on the MO HealthNet Web Portal at www.emomed.com.
- Are we required to report Medicare, inpatient hospital, and home leave days?
Yes. All days must be reported, except for Hospice days.
- What revenue code do I use when a participant is in a Medicare certified bed?
- What revenue code do I use when a participant is in the hospital?
0184 or 0185
- What revenue code do I use for home leave of absence (LOA) days?
0182 or 0183
- How do I know which patient status code to use?
Patient Status The Valid Status Codes Are: 01 Discharged to home or self care (routine discharge) 02 Discharged/transferred to another short term general hospital for inpatient care 03 Discharged/transferred to skilled nursing facility (SNF) with Medicare certification 04 Discharged/transferred to an intermediate care facility (ICF) 05
Discharged/transferred to another type of institution for inpatient care
06 Discharged/transferred to home under care of organized home health service organization 07 Left against medical advice or discontinued care 08 Discharged/transferred to home under care of a Home IV provider 20 Expired 30 Still patient 40 Expired at home 41 Expired in a medical facility (e.g. hospital, SNF, ICF, or free standing hospice) 42 Expired - place unknown 50 Hospice - home 51 Hospice - medical facility 62 Discharged/transferred to an inpatient rehab facility (IRF) 63 Discharged/transferred to a Medicare certified long term care hospital (LTCH) 64 Discharged/transferred to a nursing facility certified under MO HealthNet
The above list can also be found by accessing the “Help” feature under Nursing Home Management on the MO HealthNet Web Portal at www.emomed.com. The most frequently billed patient status code is 30, still a patient. The patient status code is determined by the resident’s status on the end (or thru) date of service indicated on the detail line on the nursing home claim form. As an example, a resident is in the nursing home 12/01/2010 - 12/05/2010. On the 5th the resident goes into the hospital and is there until discharged on the 8th. The patient status code for each segment can be 30. The first billing period would be 12/01/2010 - 12/04/2010 as the resident wasn’t in the facility for the midnight bed check on the 5th. The second billing period would be 12/05/2010 - 12/07/2010 as these were the days the resident was in the hospital. Billing of room and board would resume on the 8th when the resident returned to the nursing home.
- If a resident returns from the hospital as Medicare, what codes do I use?
You use Revenue Code “0189” – Other Leave of Absence (Medicare Qualifying stay) and continue to use Patient Status Code “30”.
- How do I track hospital days?
You use either revenue code “0184” – ICF/MR-Any Reason or “0185” – Nursing Home (for hospitalization) and continue to use patient status code “30”.
- How do I bill for a resident who was a MO HealthNet participant, went to the hospital, came back Medicare, went back to the hospital, and then came back to a semi-private room all in the same month?
Residents admitted to an inpatient hospital stay, return to the nursing home as Medicare days, back to the hospital, etc., are billed by adding detail lines. Detail lines must be in date order beginning with the oldest dates of service (DOS). Each segment appears on your remittance advice as a separate claim. In the example below, the resident was admitted to an inpatient hospital stay on November 4th. On November 8th, the resident was discharged from the hospital and returned to the nursing home as a Medicare day. A second inpatient hospital stay began November 19th and discharged on the 22nd with the resident returning to the nursing to a semi-private room.
Start DOS End DOS Patient Status Revenue Code 11/01/10 11/04/10 30 0120 11/04/10 11/07/10 30 0185 11/08/10 11/18/10 30 0189 11/19/10 11/21/10 30 0185 11/22/10 11/30/10 30 0120
- How do I bill for one participant only?
Under the Participant Summary click on the name of the participant you want to submit a claim; this will allow you to edit the participant’s information.
- Can I add a new participant to a current month’s batch billing?
Yes, click on the “New Participant” tab under Participant Summary.
- If I enter a claim and select “Submit Manually” does the claim stay out there until submitted?
Submit Manually allows a facility to print a paper claim for submission. The claim will continue to appear on the Participant Summary with an alert the claim was submitted manually until a new claim is submitted for that participant or the participant is deleted.
- Can I make online adjustments when submitting claims on the MO HealthNet Web Portal?
- Yes. Providers can submit adjustments on the MO HealthNet Web Portal at www.emomed.com. Only claims in paid status can be adjusted. Claims may either be voided or replaced. A void will show as a credit; a replacement claim will show as two transactions, the credited claim and the new, correct claim. Claims needing to be voided or replaced are done so by selecting Claims Management. The ICN (Internal Control Number) or the participant’s DCN (8-digit MO HealthNet identification number) is required information when voiding or replacing a claim.