Step-by-Step Coding Guide for Item Set Z0200: State Medicaid Billing (if required by the state)

This guide is intended to assist in accurately coding and documenting State Medicaid billing information within the MDS 3.0, specifically in item set Z0200.

1. Review of Medical Records

• Objective: Confirm Medicaid coverage details and eligibility for the resident.
• Key Points:
  • Examine the resident’s medical records for documentation of Medicaid coverage, including eligibility determination dates and any changes in coverage status.
  • Verify the resident's Medicaid identification number and coverage period pertinent to the MDS assessment period.

2. Understanding Definitions

• Objective: Clarify what encompasses State Medicaid Billing.
• Key Points:
  • State Medicaid Billing: Refers to the process of submitting claims to the state Medicaid program for services provided to eligible residents. Billing requirements and procedures can vary by state.

3. Coding Instructions

• Objective: Guide on accurately entering Medicaid billing information.
• Key Points:
  • Z0200A: Enter the Medicaid resident identifier or Medicaid number.
  • Z0200B: If applicable, code the Medicaid classification system per state requirements, which may include specific codes related to the services provided.

4. Coding Tips

• Confirm the resident’s Medicaid number and classification code with your facility’s billing department or Medicaid coordinator to ensure accuracy.
• Stay updated on your state’s Medicaid billing codes and requirements, as they may change.

5. Documentation

• Objective: Ensure comprehensive documentation to support Medicaid billing entries.
• Key Points:
  • Maintain documentation in the resident’s financial record of the Medicaid billing, including the Medicaid number, classification code, and details of the services billed.
  • Keep a record of communications with Medicaid representatives or case workers regarding the resident's eligibility and coverage.

6. Common Errors to Avoid

• Entering an incorrect Medicaid number or classification code, leading to claim denials or delays.
• Overlooking updates or changes in state Medicaid billing requirements that affect how services should be coded and billed.

7. Practical Application

• Scenario: Jane Smith, a long-term resident at the facility, is covered under the state Medicaid program for skilled nursing care services. During the MDS assessment period, the facility’s Medicaid coordinator verifies Jane's Medicaid coverage and notes that she is classified under a new Medicaid case-mix group due to recent changes in her care needs. The coordinator ensures Jane's Medicaid number and the correct case-mix group are accurately entered in Z0200A and Z0200B, respectively, and documents this in her financial record along with the date of verification.

The Step-by-Step Coding Guide for item Z0200 in MDS 3.0 Section Z is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.