Physician visits during a Part A SNF stay bill separately under Part B using codes 99304–99310 — but cloned notes, MDM-level mismatches, and missed qualifying-stay rules average $6,800 in recoupment per provider when RAC auditors come calling.
Common Billing Challenges
These are the six billing failure points we see most often in physicians billing skilled nursing facility visits — and the ones our team resolves systematically from day one.
Only formally admitted inpatient days count toward the 3-day qualifying stay for SNF Part A coverage. Observation status days don't count, even when the patient is physically in the hospital.
RAC auditors specifically look for identical language across sequential visits — a day 3 note that reads the same as a day 12 note is a red flag that triggers additional documentation requests.
Billing 99310 (high complexity) when the documentation only supports 99309 (moderate complexity) is one of the most common RAC findings in SNF physician billing.
When a patient's skilled needs end, Part A coverage ends regardless of how many benefit days remain. Billing visits past that point is a documented OIG Work Plan focus area.
The $204-per-day coinsurance for days 21–100 in 2026 has to be tracked accurately, and coverage stops entirely after day 100 — patients regularly don't know this until the bill arrives.
Part A facility per-diem and Part B physician visits are submitted to Medicare simultaneously in different payment systems with no duplication — don't let a facility's billing team tell you physician claims aren't allowed.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in SNF physician billing.
| CPT Code | Description | Common Issue |
|---|---|---|
| 99304 | SNF initial visit, low complexity MDM (~$101) | Requires the 3-day qualifying stay confirmed first |
| 99306 | SNF initial visit, high complexity MDM (~$210) | Must match documented complexity, not a template |
| 99307 | SNF subsequent visit, straightforward MDM (~$40) | Note language must vary visit to visit |
| 99309 | SNF subsequent visit, moderate complexity MDM (~$103) | Most commonly confused with 99310 on audit |
| 99310 | SNF subsequent visit, high complexity MDM (~$148) | Top RAC target when MDM doesn't support the level |
| Part B / Part A | Physician billing during a Part A stay | Billed separately from the facility per-diem, no duplication |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to post-acute and SNF billing — not a generic CPC only.
Well above facilities risking a $6,800 average RAC recoupment per provider from templated notes and MDM-level mismatches. We catch both before they go out the door.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your visit schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.