Nursing Home Facility Billing

Nursing Home Facility Billing

Nursing home services are usually provided by qualified non-physician such as:  Nurse Practitioners, Physician Assistants, and Clinical Nurse Specialists.  Each may provide care for all subsequent Skilled Nursing Facility visits and nursing home billing, but the admitting physician must make the initial visit.

The patient’s treatment is handled by the primary physician who takes care of the admission procedures and establishes an approved care plan. The admitting doctor must carry out an initial clinical examination within 30 days of admission when a patient gets admitted to a nursing facility.  The billing is processed as a follow-up.

An initial comprehensive evaluation must adhere to the nursing home billing guidelines which consist of:

  • Providing a patient evaluation, history, physical examination and medical policy decisions including diagnosis, data analysis and risk assessment are the key areas of concern.
  • To develop a care plan with the patient
  • Verify the admission orders concerning the resident nursing facility
  • All of this are taken care of within 30-days of the patient’s admission into the facility

The initial visit is recorded based on the same requirements as standard coding for evaluation and management and is calculated considering time or records such as:

  • Physical examination
  • History
  • Decision making on medical grounds

For a document the initial visit fall under CPT’s 99304-99306. Each CPT depends on certain variables and time spent with the patient. 

  • 99304: Includes detailed history and low-intensity physical examination and medical decision making. It takes 25 minutes to complete the formalities.
  • 99305: Covers a detailed overview and moderate scope of physical examination and medical diagnosis. Total time taken is 35 minutes.
  • 99306: Incorporates a thorough and extremely complex history of physical examination and decision making for further treatment. It takes 45 minutes to perform the job.

Subsequent examinations (re-exams) may be carried out by a non-physician practitioner.  For the re-exam’s the following CPT’s are utilized.


  • Complication: focused history
  • Complication: intense examination
  • Elementary medical decision making
  • Time taken: 10 minutes


  • Extended complication: focused history
  • Extended complication: intense examination
  • Low magnitude of medical decision making
  • Time spent: 15 minutes


  • Detailed examination
  • Detailed history
  • Moderate clinical policy decisions
  • Time span: 25 minutes


  • Comprehensive examination
  • Comprehensive history
  • High complexity clinical decision making
  • Total time: 35 minutes

Discharge day management services are put on record for one-on-one communication with the patient on the day of the visit. It is performed even if the patient gets discharged on a separate day.

  • 99315: 30 minutes or shorter
  • 99316: In excess of 30 minutes

When pronouncing a patient’s death, a doctor or qualified physician protractor may adopt a discharge day management service code. Service providers, except admitting doctor, who take care of the patient in a proficient nursing environment, will review the patient’s billing with the skilled nursing facility billing codes before claims submission to ensure actual billing and reimbursement follow-up.

Our specialists in billing and coding, with distinct skilled nursing facility billing guidelines, play a vital role in optimizing reimbursement and providing a competitive edge. The following value-added services are our key features:

  • Reduction in operating and overhead costs
  • Speedy disposal of medical claims
  • Continuous research and development in coding norms
  • Concentration on patient healthcare regardless of administrative functions
  • Lowering down the percentage of bad debts within two months stipulation.
  • Proper documentation with error-free coding disputes

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