What Your PointClickCare Data Is Already Telling You About Part B Billing Gaps
Eric HansenFounder, Burst BillingJuly 10, 20269 min readYour staff documents wound care, supply orders, payer status changes, and clinical notes every day. PointClickCare captures all of it.
Those records form the basis for Medicare Part B supply reimbursement claims. Most SNFs just never connect the two. The data sits in the EHR, the billing review never happens, and the revenue goes unrecovered.
Most of the time, the records are there. They just haven't been reviewed for billing.
Who Can Bill Medicare Part B for Supplies in a Skilled Nursing Facility
Part B supply billing applies to residents not in an active Part A stay. Once a resident transitions off Part A, or was admitted on a non-covered basis, certain medical supplies become billable under Part B under the facility's own NPI.
The billable categories include surgical dressings and wound care supplies, ostomy supplies, urological supplies such as catheters, and tracheostomy supplies. These fall under the Prosthetics, Orthotics and Supplies (POS) category in Medicare, a separate classification from durable medical equipment.
The statutory basis for facility-side billing goes back to the Balanced Budget Act of 1997. What most facilities still lack is a consistent process to find, document, and submit these claims.
What PointClickCare Data Can Surface for Part B Review
PointClickCare tracks useful signals across a resident's full care record. For Part B billing review, the relevant signals include:
- Resident payer status and payer status transitions
- Admission and discharge dates
- Active Part A coverage windows and when they end
- Clinical notes connected to supply use
- Wound assessments and device documentation
- Order history for recurring supplies
- Supply patterns across multiple care dates
Each signal is a data point. Together, they help a reviewer identify which records belong in a Part B review queue and which can be cleared quickly.
The goal at this stage is triage. You're using the data to route records to the right review, faster. Facilities already using the PointClickCare billing integration can turn these signals into a working review queue without adding new systems.
Where Billing Gaps Actually Hide
A missed Part B opportunity rarely looks like a blank entry.
It looks like a mismatch. A resident has weeks of consistent wound care documentation, but no billing review ever happened. Vendor invoices show recurring supply deliveries, but the chart hasn't been reviewed to confirm whether the documentation supports the item. A payer status changed mid-stay and nothing flagged it for a reimbursement review.
Each mismatch type has a different path forward. Some belong in a claim queue. Some need documentation work before they can go anywhere. Some get logged as exclusions. Finding them requires a process built to read the data and act on what it finds.
The Exclusion Log: What Most Billing Reviews Skip
Most billing reviews are organized around what to submit. A process built for audit readiness also tracks what it doesn't submit, and why.
An exclusion log captures records that went through review but were declined: missing physician order, incorrect payer status, unclear coverage path, duplicate payer concern, or documentation that doesn't support the quantity billed. Every excluded record gets a reason.
This matters for two reasons. During an audit, documented exclusions show the review applied judgment. Between audits, the exclusion log identifies where documentation gaps are concentrated, which supply types are consistently missing order support, and which upstream problems are costing the facility claims.
A billing program with no exclusion log is tracking half the process. This is where routine review connects with real Medicare audit defense.
What PointClickCare Data Should Not Be Used For
PointClickCare entries are routing signals. Claims need a Standard Written Order, clinical necessity documentation, and proof of delivery to stand on their own.
EHR data shouldn't substitute for a missing physician order. It shouldn't carry a claim through when the clinical record is ambiguous. When coverage is genuinely unclear, that goes to compliance review, not the claim queue.
The practical line: data review finds the question. Compliance review answers it. When those two steps collapse into one, claims go out on weak support, and audit defense finds them.
What Useful Output Looks Like
The most useful output from a PointClickCare Part B review is a monthly report with a consistent structure.
| Section | What it shows |
|---|---|
| Reviewed records | How many resident records were checked this month |
| Documentation gaps | Where orders, delivery proof, or status confirmation are missing |
| Pending items | Records waiting on additional support |
| Excluded records | What was not billed and why |
| Submitted claims | Approved claims that moved forward |
| Denial reasons | Patterns coming back from payers |
| Trends | Supply category or facility unit patterns worth attention |
That format turns a data review into a management tool. A facility can see whether denials are repeating for the same supply type, whether documentation gaps are concentrated in one care unit, or whether certain payer status transitions are being missed month after month. Each pattern has a fix.
A reporting structure is what turns a billing process into a billing program. For facilities working to standardize this, connect the report with your internal SNF Part B billing compliance workflow.
How Burst Medical Billing Uses PointClickCare for This Work
Burst connects to PointClickCare through the official Marketplace integration. Read-only access, with a Business Associate Agreement in place before we see any resident data.
Our process uses that connection to surface the review questions first: is payer status correct for this resident, does the documentation support this item, is the date range clean? Records that clear those questions move to human compliance review before any claim decision. Records that don't go to the exclusion log.
When we do a free assessment for a new facility, we review 12 months of PointClickCare data and deliver a written, code-level estimate of what Part B reimbursement may be available, before any commitment is made.
If you want to know what your data shows, that's where to start.
Compliance Note
This article is for general educational purposes only. It does not replace facility-specific billing, compliance, legal, or payer guidance. SNFs should verify coverage, coding, documentation, and submission decisions against applicable CMS guidance, payer rules, and their own compliance policies.
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Written by
Eric Hansen
Founder, Burst Billing
Eric Hansen is the founder of Burst Billing. He has spent over a decade helping skilled nursing facilities recover missed Medicare Part B supply reimbursement through cleaner documentation, tighter vendor workflows, and risk-free billing reviews.
More from Eric →Frequently asked questions
- Yes. SNF residents who are not in an active Part A stay may be eligible for Part B supply billing under the facility's own NPI. Eligible categories include surgical dressings and wound care supplies, ostomy supplies, urological supplies such as catheters, and tracheostomy supplies. Each claim requires a Standard Written Order, clinical documentation supporting medical necessity, and proof of delivery.
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