Frequently Asked Questions, Filing Nursing Facility Claims

What are the revenue codes to be used when billing nursing home claims to MO HealthNet?

Valid codes are shown in the chart below.

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.

Yes. All days must be reported, except for Hospice days.

0189

0184 or 0185

0182 or 0183

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.

You use Revenue Code “0189” – Other Leave of Absence (Medicare Qualifying stay) and continue to use Patient Status Code “30”.

You use either revenue code “0184” – ICF/MR-Any Reason or “0185” – Nursing Home (for hospitalization) and continue to use patient status code “30”.

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.

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.

Yes, click on the “New Participant” tab under Participant Summary.

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.

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.