Study of First Visits for Patients In SNF

April 11, 2019
Policy Snapshot

A study, Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities, published in the April edition of Health Affairs, examined the timeliness of the first visit after discharge from an acute care facility. The authors from the University of Pennsylvania found that while the majority of patients were seen either by a physician or an advanced practitioner within the first four days, some patients were not seen, which affected outcomes and mortality.

While the Medicare requirements state that a patient has to be seen within the first 30 days, the reality is that the majority of patients need to be seen much sooner than that and in fact, many states and facilities have much stricter requirements. The study also noted that a first visit can be performed by a physician or an advanced practitioner before the initial assessment and coded as a “subsequent care visit” as defined by CPT codes 99307-99310.

Billing for these visits has long been a point of confusion among PALTC clinicians, so it is critical to understand these regulatory requirements. The Society has previously stated that patients must be seen in a timely manner for medically necessary visits, including the first visit before a comprehensive initial visit as defined by CPT codes 99304-99036. The Society also published a white paper on medical necessity.