Recovery Audit Contractors: This RAC Sets Sights on E/M Services Performed in SNFs

Why This Topic Matters

Skilled nursing facility E/M services are a frequent source of audit scrutiny, and errors can create claim risk for routine visits, consultation-style encounters, and specialist involvement. The article helps readers understand the general coding and documentation issues that may affect compliance and claim support.

Article Sections

1. Audit focus on SNF E/M services

   Introduces the audit topic and the general concern about evaluation and management services in skilled nursing facilities. Summarizes the broad categories of visits under review and the time frame mentioned by the audit source.

2. Know How to Tally E/M

   Addresses how to think about nursing-facility evaluation and management reporting when patient encounters differ in purpose and documentation. The section discusses general criteria for distinguishing types of visits and the role of key elements in code selection.

3. Nail Down Timing

   Covers time-based reporting concepts for nursing facility E/M services and the documentation elements associated with them. It also discusses the relationship between time, counseling and coordination of care, and standard documentation requirements.

4. Rules Should Stay the Same for Specialists

   Explains that specialty physicians may also report nursing facility E/M services and highlights the need to pay attention to Medicare guidance. The section introduces place-of-service considerations and references a physician-of-record modifier used in this setting.