Nursing Facility Patient Status Codes
When completing a nursing facility claim, providers should ensure they are using the correct Patient Status Code. Providers should ensure that when a MO HealthNet participant is leaving the nursing facility, but plans to return, they use Patient Status Code 30 (Still a patient). For example, if the participant is admitted to the hospital for three days and returns to the nursing facility on the fourth day, the Patient Status should remain 30, “Still a patient.”
If a MO HealthNet participant is discharged to a hospital and expires, the provider should bill revenue code 185 for the hospital segment, and update the Patient Status Code to 20, “Expired.”
If the participant is discharging home or to another facility the Status Code should be changed to the appropriate Status Code for the situation. The complete list of codes is below and can also be found by accessing the Help feature under Nursing Home Management in eMOMED.
When completing a nursing facility claim, claims must be received in date order and the claim must be in “Paid” or “To be paid” status before providers should submit the next date span for payment.
For questions regarding billing, contact Provider Communications via the Provider Management function in eMOMED or call (573) 751-2896.
Patient Status Code | Description |
|---|---|
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) |
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 a 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 |