A strong physician query process is key to SNF compliance, reimbursement, and care quality. Learn how to build one that works.
In the rapidly evolving landscape of skilled nursing facilities (SNFs), accurate clinical documentation is not just a matter of good recordkeeping; it's a cornerstone of compliance, quality care, and financial stability. One of the most powerful tools in strengthening documentation is a well-structured physician query process. Yet, in many SNF settings, this process is either informal, inconsistent, or entirely absent.
At Polaris Group, we partner with SNFs across the country and have seen firsthand how a structured physician query process can dramatically improve outcomes, reimbursement and compliance. In this article, we break down why SNFs need a strong query process, what it should look like, and how to implement it effectively.
Why Physician Queries Matter in the SNF Environment
Accurate Diagnosis Coding: Physician queries clarify ambiguous, conflicting, or missing documentation that can impact diagnosis-related group (DRG) assignment and resource utilization group (RUG) or PDPM classification. A small documentation gap can lead to large reimbursement discrepancies or even compliance risk.
Regulatory Compliance: SNFs are under increasing scrutiny from CMS and state survey agencies. A strong query process ensures that documentation aligns with clinical findings, supporting care decisions and protecting against audit risk.
Quality Measures and Star Ratings: Clear, complete documentation directly affects SNF Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) outcomes, influencing both public perception and reimbursement.
Continuity of Care: When patients transition between care settings, complete documentation is essential for accurate continuity of care. Queries support this by ensuring all pertinent conditions are captured and clearly defined.
Key Elements of a Strong Physician Query Process
We recommend a best-practice query process that is structured, compliant, and collaborative. Here’s what it includes:
Clear Protocols: Defined workflows for when and how to initiate a query, who reviews it, and how responses are tracked.
Education: Ongoing training for clinical staff and providers on the importance of documentation and the role of queries.
Query Templates: Standardized, compliant query templates based on AHIMA, ACDIS and CMS guidelines.
Secure Communication: HIPAA-compliant systems for sending, receiving, and storing queries.
Data Monitoring: Regular audits to identify trends, training needs, and process improvement opportunities.
Implementing the Process: A Step-by-Step Guide
- Perform a Gap Analysis - Review current documentation practices, coding audits, and query practices (if any). Identify common documentation deficiencies or missed opportunities.
- Designate a Query Champion - Assign responsibility to a nurse leader, MDS coordinator, or billing office specialist who understands both clinical language and coding impact.
- Develop Policies and Procedures - Draft clear internal guidelines: when to query, what constitutes a leading question, and turnaround time expectations for providers.
- Implement Training - Train nursing, therapy, and provider staff on the why and how of queries. Include real-world case studies and compliance risks.
- Choose the Right Tools - Whether using EHR-integrated solutions or secure communication platforms, ensure queries are easy to issue, document, and track.
- Monitor and Improve - Review query response rates, accuracy of final documentation, and denial trends. Adjust the process based on outcomes and feedback.
Final Thoughts
In a healthcare climate where compliance, quality, and financial integrity are deeply interconnected, SNFs can no longer afford to treat physician queries as optional. A well-structured query process is not just a coding initiative—it’s a quality assurance and risk management imperative.
SNF leaders who prioritize documentation integrity will not only optimize reimbursement but also enhance patient care and position their organizations for long-term success.
If your facility needs support in developing or refining a physician query process, Polaris Group is here to help. Our consultants offer tailored assessments, training, and implementation support to ensure your process is efficient, compliant, and impactful.
