The Day Part A Ends, Part B Supply Billing Opens

When a resident's Part A stay ends, consolidated billing lets go of everything except therapy. From that day, Medicare Part B pays your facility for surgical dressings, ostomy supplies, urological supplies (catheters included), tracheostomy supplies, and splints and braces. The claim goes to your A/B MAC under the facility's NPI. A written order and a chart that backs it up still have to be there.

SNF billing training gives consolidated billing its own section. The rule is clean: while a resident is on Part A, the per diem covers the supplies and Part B stays out of it. You learn it and move on.

Then the binder closes. The day Part A ends gets one line, if it gets that.

That missing page is where the money is.

What consolidated billing blocks during Part A

Part A works like a buffet. Medicare pays your facility one flat rate per day, and everything on the table is included: the room, the meals, the nursing, the dressings. The rolls never show up on a ticket.

That's consolidated billing. During a covered Part A stay, an outside supplier can't send Medicare a separate bill for something the per diem already paid for. The rule sits at 42 CFR §411.15(p)(1).

The next paragraph of that reg, (p)(2), lists what stays separately billable even during Part A: physician services, certain dialysis, hospice, certain chemotherapy drugs, customized prosthetics. CMS keeps a plain-English version on its SNF consolidated billing page.

What changes the day Part A ends

Part A ends when a resident runs out of covered days or stops needing skilled care. Some residents never had it at all, because there was no 3-day hospital stay.

The buffet price ends that day. The resident is still at the table, and the dressings keep coming out of the kitchen.

Now each one can go on a ticket. CMS puts it plainly: for a resident in a non-covered stay, only therapy stays under consolidated billing. Physical, occupational, and speech therapy remain the facility's to bill. Everything else Part B covers can be billed on its own.

Here's where the ticket goes:

• To your A/B MAC, on a UB-04, type of bill 22X, under the facility's NPI.
• Surgical dressings under revenue code 623. Prosthetic and orthotic devices under 274.
• Medicare pays the facility.
• You have 12 months from each date of service to file (42 CFR §424.44).

A team trained only on the Part A rule keeps cooking and never rings anything up.

The 5 supply categories Part B pays for

CMS lists the Part B benefits for SNF residents in the Medicare Benefit Policy Manual, Chapter 8, §70. The Social Security Act sits underneath it.

• Surgical dressings: SSA §1861(s)(5).
• Splints and braces: splints and casts under §1861(s)(5), braces under §1861(s)(9).
• Ostomy supplies: §1861(s)(8), the prosthetic device benefit. The statute names colostomy bags.
• Urological supplies, catheters included: §1861(s)(8), by way of CMS's manual (Benefit Policy Manual, Chapter 15, §120).
• Tracheostomy supplies: §1861(s)(8) as well. CMS treats them as prosthetic device supplies.

"Prosthetic device" has a specific meaning here: something that replaces a body function that's permanently gone. A catheter stands in for a bladder that won't empty. Hold on to the word "permanently." It comes back when you get to the chart.

Two things that stay off this claim

Enteral nutrition has its own lane

Part B covers tube feeding for a non-Part A resident under the same prosthetic device benefit, when the impairment is permanent. Formula a resident drinks isn't covered.

The enteral claim goes to the DME MAC, and whoever bills it (the facility or an outside supplier) needs DMEPOS supplier enrollment. It never rides on the UB-04 to your A/B MAC. CMS spells this out in its enteral nutrition policy article.

Medicare Advantage plans have to cover what traditional Medicare covers, tube feeding included. Each plan runs its own authorization and billing rules, so check the plan at admission.

Durable medical equipment is a flat no

Medicare doesn't pay for a wheelchair, a hospital bed, oxygen equipment, or a CPAP used inside a SNF. The DME benefit only exists in a patient's home, and CMS says a SNF isn't one. Your facility supplies that equipment and eats the cost. Burst doesn't bill DME.

The resident who leaves Part A twice

Residents move on and off Part A. How they get back on depends on how they left.

A resident with days left in the bank drops off Part A when the skilled need ends. A new 3-day hospital stay turns Part A back on for the days that remain. (So does a return to skilled care inside 30 days.)

A resident who burned all 100 days has a longer road. Medicare needs 60 days in a row without hospital care or skilled care before the benefit period ends. Then a new 3-day hospital stay starts a fresh 100.

Either way, every exit from Part A opens the Part B window again.

Track payer status by date, for each resident, and you catch every exit. A payer status recorded once at admission shows you none of them.

The residents who cycle like this are your long-stayers with chronic wounds, catheters, ostomies, and trachs. They use these supplies every day they're in the building.

What the claim stands on

A status change opens the window. The claim stands on paper.

Start with the order. Every supply needs a written order from the treating practitioner: a physician, NP, PA, or clinical nurse specialist.

The federal order rule (42 CFR §410.38(d)) sets the clock. The order has to be in hand before the claim goes out. Items on CMS's Required Face-to-Face Encounter and Written Order Prior to Delivery List need it before delivery.

Get it before the first supply anyway. An order dated ahead of the supply ends the argument before an auditor starts one.

Check any order written during the Part A stay. If the supply or the quantity has changed since, get a new one.

Then the chart. The diagnosis codes on the claim have to match what the clinical record says. Wound claims need wound assessments with type, size, drainage, and dates. Catheter claims need the permanent condition behind the catheter. CMS reads "permanent" as long and indefinite duration, in the treating practitioner's judgment.

A claim missing the order or the chart support gets denied, or paid and then taken back in an audit. Payer status can't save it.

I taught myself Medicare billing out of manuals and denials. It took 2 years, and I still look up the reg before I trust my memory. Do the same with this article. Every source is at the bottom.

Find the dates your window opened

Sources

• 42 CFR §411.15(p), services furnished to SNF residents
• CMS, SNF Consolidated Billing
• Medicare Claims Processing Manual, Chapter 7, SNF Part B billing
• Medicare Benefit Policy Manual, Chapter 8, §20.2.3 and §70
• Medicare Benefit Policy Manual, Chapter 15, §100, §120, §130
• Social Security Act §1861(s)
• 42 CFR §410.38, DMEPOS scope and conditions
• CMS, DMEPOS order and face-to-face encounter requirements
• 42 CFR §424.44, time limits for filing claims
• CMS, Enteral Nutrition Policy Article (A58833)
• CMS MLN, Medicare DMEPOS Payments While Inpatient
• Medicare.gov, Medicare Coverage of Skilled Nursing Facility Care