Frequently Asked Questions, Filing Nursing Facility Claims
Nursing facilities began filing claims through the Internet at emomed.com in October 2003. You must use 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.
How do providers stay current on MO HealthNet policy?
Providers should sign up for the MO Health News distribution list. Providers will receive Bulletins, Hot Tips, and email blasts informing them of any changes that may affect them or their patients.
Sign up for MO HealthNet News under the Email Updates on the Provider Page.
Is the attending provider’s NPI required on the Nursing Home claim?
Does the attending provider have to be enrolled?
Yes. The provider must be enrolled or the claim will deny.
What revenue codes are 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|
|0120||Room – Board/Semi|
|0184||ICF/MR – Any Reason|
|0185||Nursing Home (for Hospitalization)|
|0189||Other Leave of Absence (Medicare Part A days)|
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 Nursing Home per diem is the same regardless if a non–skilled or skilled revenue code is billed.
Are we required to report Medicare, inpatient hospital, and home leave days?
Yes. All days must be reported, except for Hospice days.
How do I know which patient status code to use?
The patient status code should be 30 “Still patient” if the patient leaves the facility and is planning on returning.
Example 1: The patient is admitted to the hospital for 3 days and returns to the facility on the 4th day. The patient status should remain 30 “Still patient.”
Example 2: The patient discharged to the hospital and expires. The provider should bill revenue code (185) for the hospital segment and change the patient status to 20 “Expired.”
Example 3: If the patient is discharging home or to another facility the status code should be changed to the appropriate status code below.
|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)|
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|
|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.
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 line segments on the Nursing Home Claim. Line segments 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 April 4th. On April 8th, the resident was discharged from the hospital and returned to the nursing home on Medicare A days. A second inpatient hospital stay began April 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|
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?
The "Submit Manually" option 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.