Frequently Asked Questions, Filing Nursing Facility Claims

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Is the attending provider’s NPI required on the Nursing Home claim?
Yes

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.

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.

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

0189

0184 or 0185

0182 or 0183

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.

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.

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 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.

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.

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.

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.