Claimocity Claims
Billing Services for SNFists:
The Rising Star of Inpatient Medical Specialties
What is an SNFist?
A SNFist, also known as a SNF-ist or SNFologist, is a physician specializing in senior or recovering patient care mainly within Skilled Nursing Facilities (SNFs). Typically, these physicians generate 80-90% of their billing claims from this type of post-acute care. Like hospitalists, they often provide care across multiple facilities, but SNFists work in diverse settings such as inpatient rehab facilities (IRFs), long-term acute care hospitals (LTACHs), and conventional SNFs. While the term “SNFist” emerged about six years ago, a standardized definition is yet to be established.
Primary specialties of SNFists include internal medicine and family medicine, as well as physical medicine and rehabilitation (PM&R or Physiatry), geriatric medicine, geriatric psychiatry, and palliative care. Additional specialists may visit associated facilities as required for specialized treatment and diagnostics.
Numerous studies underscore the vital role of SNFists in reducing preventable hospital readmissions and improving patient outcomes compared to generalist physicians.
SNFist vs Hospitalist Billing Services
Much like hospitalists, most SNFists are contracted to work at skilled nursing facilities rather than being employees. This means they require their own billing solution, while also working with multiple EHR systems across facilities. Given the complexities of SNFist billing and the challenges of maintaining an in-house team, it’s no surprise that over 80% of SNFists opt for outsourced billing services.
While they’re both inpatient physicians who do a lot of rounding, SNFists and hospitalists differ primarily in their practice settings and medical specialties. These differences are reflected in their billing and potential claim denials. While hospitalists must deal with critical care codes and patient admission status, SNFists must deal with a complex schedule of regulatory visits and different sets of POS codes for skilled stays vs long-term custodial care. They must also deal with differences between Medicare, Medicare Advantage, Medicaid, and dual-eligible patients.
Custom Software and Billing Services for SNFists
When we built our software platform and RCM services for inpatient care, SNFists and other post-acute care providers never played second fiddle to hospitalists. We know that SNFists require software that integrates seamlessly with the predominant EHR systems used in skilled nursing facilities: PointClickCare (PCC) with a 70-80% market share and MatrixCare, which, following the acquisition of SigmaCare, controls the majority of the remaining 20-30%. These integrations are vital for efficient workflow and accurate patient documentation within the facility’s chosen EHR platform.
Challenges of Using a Secondary EHR
Some SNFist practices use a secondary EHR for charting before transferring data to the facility’s primary EHR. While this offers convenience and quality assurance, it brings significant downsides. Apart from the high monthly cost, there’s an increased risk of data loss, exposure, and liability. Transferring data between systems introduces human error and security vulnerabilities, with potential legal implications. Thus, relying on a secondary EHR adds complexity and risk for SNFist practices. Now there’s a better solution.
Enhanced Integration with PCC and MatrixCare
Numerous charge capture, practice management, and billing software systems collaborate with PCC and/or MatrixCare for integrated solutions. However, Claimocity is the premier integration partnership, enabling direct pulling and pushing of progress notes into the EHR system. This coded data flow facilitates real-time updates across both systems, streamlining workflow and eliminating manual data entry. This advanced connectivity not only saves time by automating patient data input but also enables seamless progress notes integration and simultaneous billing and charting at the point of care, enhancing efficiency and reducing administrative burdens.
What is SNF Consolidated Billing?
SNF consolidated billing is a Medicare rule that makes the skilled nursing facility responsible for billing Medicare for nearly all of the services a resident receives during a covered Part A stay. That includes services the facility doesn’t provide itself, such as therapy, lab work, medical supplies, and the technical component of imaging and other diagnostic tests. Outside suppliers bill the SNF for that work instead of billing Medicare directly, and the facility receives a bundled payment for the stay.
Physician services are the major exception. Professional services from physicians, nurse practitioners, physician assistants, and certain other practitioners are excluded from consolidated billing. That means an independent SNFist still bills Medicare Part B under their own NPI for every visit, regardless of how the facility handles the rest of the patient’s care. This type of split billing is a common source of claim denials for the SNFist, which Claimocity’s billing solution can help you avoid.
How SNFists Affect Hospital Readmissions
Hospital readmissions are one of the most closely watched quality measures in post-acute care. Hospitals weigh a facility’s rehospitalization rate when deciding where to refer patients. With Medicare’s SNF Value-Based Purchasing Program, facilities face payment reductions or penalties when those rates run high.
Nursing homes have turned to SNFists in growing numbers. A national study published in JAMA Network Open in 2023 found that the share of nursing homes using at least one SNFist grew from 13.5% in 2013 to 52.9% in 2018. The same study looked at what happened after facilities brought SNFists on. Postacute admissions increased, and rehospitalization rates held steady. In practice, that means facilities with SNFists were able to take on more post-acute patients without seeing their readmission rates go up.
Growth Trends and Research Findings
There’s a noticeable trend in nursing homes towards admitting higher acuity patients. This shift creates a growing demand for SNF-focused specialist physicians who can cater to these patients without navigating the hurdles often found in corporate medicine and hospital high acuity units (HAU). Instead, these specialists can play a pivotal role in treating higher acuity patients within the facility’s protocols, which prioritize both provider and patient needs.
Numerous scientific studies have examined the role of SNF physicians in delivering care to skilled nursing facility patients. Below are a few examples:
- Use of Clinicians Who Focus on Nursing Home Care Among US Nursing Homes and Unplanned Rehospitalization. Kim S, Ryskina KL, Jung HY. JAMA Network Open. 2023;6(6):e2318265. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10267770/. In a national study of 4,482 nursing homes, the share of facilities using SNFists grew from 13.5% in 2013 to 52.9% in 2018. Facilities that adopted SNFists took on more post-acute patients while keeping their 30-day rehospitalization rates steady.
- Association between Timing of Clinical Evaluation by a Physician or Advanced Practitioner and Risk of Rehospitalization in Older Adults Admitted to a Skilled Nursing Facility Following Hospitalization: A Cohort Study. Ryskina KL, Geng Z, Raghavan S, Waddell KJ, Burke RE. JAMDA. 2023;24(12):1881-1887. https://pubmed.ncbi.nlm.nih.gov/37837998/. The study covered 2,482,616 Medicare fee-for-service beneficiaries aged 66 or older who entered an SNF for post-acute care following hospitalization.
- The Characteristics of Physicians Who Primarily Practice in Nursing Homes. JAMDA. Published online November 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC9288658. It found 59.9% of SNFists specialized in internal medicine or family practice compared to 25.8% of non-nursing home clinicians.
- Influence of Admitting Clinician on Outcomes in Post-Acute Facilities. Health Services Research, 2025. https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.70017. Using a sample of 81,789 post-acute patients seen by 6,273 SNFists at 1,479 facilities between 2016 and 2019, the authors concluded that the admitting clinician appears to have little influence on key outcomes in the post-acute setting.
