Frequently Asked Questions

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:	Notes/Comments
0110	Room - Board/Pvt	Non-skilled Nursing Services Use these codes when you previously would have indicated a skilled nursing indicator of "N" or "blank"
0119	Other/Pvt
0120	Room - Board/Semi
0129	Other/2 Bed
0190	Sub-acute	Skilled Nursing Services Use these codes when you previously would have indicated a skilled nursing indicator of "Y"
0191	Sub-acute/Level I
0192	Sub-acute/Level II
0193	Sub-acute/Level III
0194	Sub-acute/Level IV
0199	Sub-acute/Other
		Reserve Type Periods
0180	General Classification	Non-covered leave of absence
0182	Patient Convenience	Home leave of absence (LOA)
0183	Therapeutic Leave	Home LOA
0184	ICF/MR - Any Reason	Inpatient hospital leave
0185	Nursing Home (for Hospitalization)	Inpatient hospital leave
0189	Other Leave of Absence	Medicare qualifying stay days

• How do I know which revenue code to use?

The majority of nursing home providers bill with revenue code 0120, room-board/semi-private.

Revenue codes 0110-0129 indicate what were previously non-skilled nursing services. Billing revenue codes 0190-0199 indicates 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 on the nursing home claim format. The link to the nursing home claim format is accessed at www.emomed.com.

• Revenue codes 0180-0189 replace the old reserve type codes;
• Revenue code 0180 is non-covered LOA;
• Revenue codes 0182 and 0183 are home LOA:
• Revenue codes 0184 and 0185 are inpatient hospital leave days; and
• Revenue code 0189 is used for Medicare qualifying stay days.
• Are we still required to report Medicare, hospital, and LOA days, as in the past?

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?

0189

• What revenue code do I use when a participant is in the hospital?

0184 or 0185

• What revenue code do I use for home LOA days?

0182 or 0183

• How do I know which patient status code to use?

A complete list of the two digit patient status codes and their descriptions may be found by accessing the "help" feature on the nursing home claim format. The link to the nursing home claim format is accessed at www.emomed.com. Patient status "9", still a patient, was replaced with "30", which is the most common status code used. The correct patient status code is determined by each individual resident's status on the last day indicated on the detail record.

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) w/Medicare cert
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

As an example, a resident is in the nursing home from 04/01-04/10/04. On the 10th the patient goes into the hospital. The patient status code would be "02" for the detail line dated 04/01-04/10/04 and the system correctly calculates the nine days to be paid to the nursing home. Refer to help screen for a list of patient status codes.

• If a resident is discharged to the hospital, do I use Patient Status Code "02" - Discharge/transferred to another short term general hospital for inpatient care?

Yes

• 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 Revenue Code "0189" - Other Leave of Absence (Medicare Qualifying stay) 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 Medicare all in the month of April?

Residents who are admitted inpatient, return to the nursing home as Medicare day, 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. Each segment will appear on the remittance advice as a separate claim.

	From Date Amt 1	Thru Date Payer 2	Pat Stat Amt 2	Rev Code Payer 3
1	04/01/2004	04/05/2004	30	0120
2	04/06/2004	04/10/2004	30	0120
3	04/11/2004	04/14/2004	30	0189
4	04/15/2004	04/17/2004	30	0185
5	04/18/2004	04/30/2004	30	0189

• How do I bill for one participant only?

You must select at least one resident from the patient summary file. To edit information from an existing resident, click on "Edit Patient"; to add a new resident , click on "Add Patient".

• Can I add a new participant to a current month's batch billing?

No, you must bill a new participant on a separate claim and then the next month it will be added to the facility's patient summary file.

• If I enter a claim and select "Validate and Print" does that claim stay out there until submitted?

Validate and print allows a facility to print a paper claim for submission. The claim will show on daily summary as a "print patient", not as submitted.

• Can I make an on-line adjustment when billing over the Internet?

Yes, providers can submit adjustments on emomed.com.

To correct a claim in paid status:

1. Enter the claim with the corrected information on the nursing home claim format.
2. Enter the ICN of the incorrectly paid claim in the original reference number field.
3. Choose frequency code "7" for replacement.

When this transaction is processed, the original claim will be recouped and the corrected claim will process as a new claim.

To credit a claim in paid status:

1. Enter the claim as it was originally submitted and processed.
2. Enter the ICN of the incorrectly paid claim in the original reference number field.
3. Choose frequency code "8" for void.
4. When this transaction is processed, the original claim will be recouped.

Claim frequency type "1" should be used for all claim submissions or resubmissions except for replacement claim (7) or void claim (8). If the frequency code is left blank, it automatically defaults to one (1).

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