Nursing Home Facility Claims FAQs
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 https://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 receive updates by subscribing to MO HealthNet News. Once subscribed, providers are notified by e-mail as updates occur. To subscribe, click here.
Providers can also visit MO HealthNet News and search by date, program, or keyword to locate updates posted over the last ten years.
- What system does MO HealthNet use to file claims?
Providers must use eMOMED to transmit MO HealthNet claims in a Health Insurance Portability and Accountability (HIPAA) compliant manner. Users can apply for a user identification (ID) and password by selecting the “Not Registered? Register Now!” link in eMOMED. Once the application is completed, you will be assigned a user ID and password. After you receive your user ID and password, you can immediately log onto eMOMED and begin using the site.
For more information on eMOMED access, refer to Section 3.3 of the General Sections Provider Manual.
- Is the attending provider’s NPI required on the Nursing Home claim?
Yes, the National Provider Identifier (NPI) is required when submitting a nursing home claim.
- Does the attending provider have to be enrolled as a MO HealthNet provider?
Yes, the attending provider must be enrolled with the MO HealthNet Division, or the claim will be denied. For enrollment information, visit Missouri Medicaid Audit and Compliance (MMAC) Provider Enrollment.
- What revenue codes are used when billing Nursing Home claims to the MO HealthNet Division (MHD)?
Valid revenue codes are shown in the chart below.
This chart also includes the revenue codes that should be utilized if a participant is in one of the following:
- Medicare-certified bed
- Hospital
- Leave of Absence (LOA)
Refer to Section 5 of the Nursing Home Provider Manual for more information.
Revenue Code Description Revenue Code 0110 Description room-board/private Revenue Code 0119 Description other/private Revenue Code 0120 Description room-board/semi Revenue Code 0129 Description other/2 bed Revenue Code 0190 Description subacute care general classification Revenue Code 0191 Description subacute care – level I Revenue Code 0192 Description subacute care– level II Revenue Code 0193 Description subacute care– level III Revenue Code 0194 Description subacute care– level IV Revenue Code 0199 Description subacute care other Revenue Code 0180 Description leave of absence (non-covered leave of absence) Revenue Code 0182 Description patient convenience (home leave) Revenue Code 0183 Description therapeutic leave (home leave) Revenue Code 0184 Description ICF/MR – any reason (inpatient hospital leave) Revenue Code 0185 Description nursing facility; for hospitalization (inpatient hospital leave) Revenue Code 0189 Description other leave of absence (Medicare qualifying stay days) - How does a provider 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 of whether a non–skilled or skilled revenue code is billed.
Refer to Section 5 of the Nursing Home Provider Manual for more information.
- Are providers required to report Medicare, inpatient hospital, and home leave days?
Yes. All days must be reported on eMOMED utilizing the Nursing Home Management function. The only exception to this rule is Hospice days.
- How does a provider know which patient status code to use in eMOMED?
The patient status code should be 30 (Still patient) if the patient leaves the facility and plans to return.
Example 1: The patient is admitted to the hospital for three 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 (0185) 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 below list can also be found by accessing the Help feature under Nursing Home Management on eMOMED.
Patient Status Description Patient Status 01 Description Discharged to home or self-care (routine discharge) Patient Status 02 Description Discharged/transferred to another short-term general hospital for inpatient care Patient Status 03 Description Discharged/transferred to skilled nursing facility (SNF) w/Medicare cert Patient Status 04 Description Discharged/transferred to an intermediate care facility (ICF) Patient Status 05 Description Discharged/transferred to another type of institution for inpatient care Patient Status 06 Description Discharged/transferred to home under the care of an organized home health service
organization
Patient Status 07 Description Left against medical advice (AMA) or discontinued care Patient Status 08 Description Discharged/transferred to home under the care of a Home IV provider Patient Status 20 Description Expired Patient Status 30 Description Still patient Patient Status 40 Description Expired at home Patient Status 41 Description Expired in a medical facility (e.g., hospital, SNF, ICF, or free-standing hospice) Patient Status 42 Description Expired - place unknown Patient Status 50 Description Hospice - home Patient Status 51 Description Hospice - medical facility Patient Status 62 Description Discharged/transferred to an inpatient rehab facility (IRF) Patient Status 63 Description Discharged/transferred to a Medicare-certified long-term care hospital (LTCH) Patient Status 64 Description Discharged/transferred to a nursing facility certified under MO HealthNet - If a resident returns from the hospital covered by Medicare, what codes should a provider use in eMOMED?
Providers should use Revenue Code 0189 (Other Leave of Absence (Medicare Qualifying stay)) and continue to use Patient Status Code 30 (Still patient).
- How do providers track hospital days in eMOMED?
Providers should use either revenue code 0184 (ICF/MR-Any Reason) or 0185 (Nursing Home (for hospitalization)) and continue to use patient status code 30 (Still patient).
- How do providers bill for a resident who was a MO HealthNet participant, went to the hospital, came back covered by 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 in eMOMED when they utilize the Nursing Home Management function. Line segments must be in date order beginning with the oldest date of service (DOS). Each segment appears on the provider’s remittance advice as a separate claim.
In the example below, the resident was admitted to an inpatient hospital stay on April 4. On April 8, the resident was discharged from the hospital and returned to the nursing home on Medicare A days. A second inpatient hospital stay began April 19, and the resident was discharged on April 22. The resident returned to the nursing home to a semi-private room.
Start DOS
Revenue Code
Patient Status Code
Days/ uUnits
Start DOS
04/01/22Revenue Code
0120
Patient Status Code
30
Days/ uUnits
3
Start DOS
04/04/22Revenue Code
0185
Patient Status Code
30
Days/ uUnits
4
Start DOS
04/08/22Revenue Code
0189
Patient Status Code
30
Days/ uUnits
11
Start DOS
04/19/22Revenue Code
0185
Patient Status Code
30
Days/ uUnits
3
Start DOS
04/22/22Revenue Code
0120
Patient Status Code
30
Days/ uUnits
9
- How do providers bill for one participant only?
Utilizing the Nursing Home Management function in eMOMED. Providers should review the Participant Summary header and click on the name of the participant they want to submit a claim for; this will allow the provider to edit the participant’s information. Once the provider has entered the necessary information, select Submit Claim.
- Can a provider add a new participant to a current month’s batch billing?
Yes, Utilizing the Nursing Home Management function in eMOMED. Click the New Participant tab under the Participant Summary header to add a new participant.
- Can I add a new participant to a current month’s batch billing?
Yes, Utilizing the Nursing Home Management function in eMOMED. Click the New Participant tab under the Participant Summary header to add a new participant.
- What occurs when a provider enters a claim and selects Submit Manually? Does the claim stay pending until it is 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 that the claim was submitted manually until a new claim is submitted for that participant or the participant is deleted.
- Can providers make online adjustments when submitting claims in eMOMED?
Providers can submit adjustments on claims in paid status only in eMOMED. Claims can be voided or replaced by selecting the Claims Management function in eMOMED.
- A void will show as a credit
- A replacement claim will show as two transactions, the credited claim and the new correct claim
When voiding or replacing a claim, the Internal Control Number (ICN) or the participant’s 8-digit MO HealthNet identification number (DCN) is required.
Revised October 2024