Supplier-Billed vs. Facility-NPI Medicare Part B Billing for SNFs
Eric HansenFounder, Burst BillingSeptember 4, 20268 min readThe money already exists. Medicare Part B pays for medical supplies furnished to residents who are not in a covered Part A stay. The open question in most skilled nursing facilities is not whether that revenue exists. It is who receives it.
Part B covers five supply categories in this setting: surgical dressings, ostomy, urological, tracheostomy, and splints and orthotics. In many buildings, none of that reimbursement reaches the facility. The reason sits in a single field on the claim: the billing NPI.
How Medicare Part B Supply Billing Actually Works
The billing NPI tells CMS who to pay. When an outside supplier submits the claim under its own NPI, Medicare pays the supplier. When the facility submits the claim under its own NPI, Medicare pays the facility. The supply, the resident, and the clinical documentation can be identical in both cases. The payee is not.
For a resident who is not in a covered Part A stay, a dual pathway exists. An enrolled supplier may bill the DME MAC, or the facility may bill its A/B MAC under its own NPI. Both are permitted. Only therapy remains bundled outside a covered stay under the SNF consolidated billing rules established by the Balanced Budget Act of 1997.
The Supplier-Billed Model
In the supplier-billed model, the supply vendor bills under its own NPI and collects the Medicare reimbursement. The facility receives the product and $0 in Part B supply revenue. For many operators, that arrangement was never a decision. It came bundled with the supply contract.
There is a compliance dimension as well. CMS launched the CRUSH initiative, Comprehensive Regulations to Uncover Suspicious Healthcare, in February 2026, with DMEPOS suppliers as a primary target. CMS reports it stopped $1.5 billion in suspected fraudulent DMEPOS billings in 2025. Supplier claims submitted for residents during covered Part A stays are the unbundling pattern auditors already know how to find.
The Facility-NPI Model
In the facility-NPI model, the facility is the billing entity. Reimbursement goes directly to the facility. The billing mechanics are governed by CMS Pub. 100-04, Chapter 7.
Filing a clean claim under this model requires four things in place at the time of service:
- A Standard Written Order from the ordering physician
- Medical necessity documentation tied to a covered diagnosis
- Proof of delivery, which for supplies is typically the MAR or nurse documentation
- HCPCS coding matched to the applicable Local Coverage Determination
The Compliance Case for Facility-NPI Billing
The supplier-billed model creates structural compliance exposure for the facility. SNFs carry responsibility for the Medicare services their residents receive. During a covered Part A stay, a separate supplier claim for a bundled supply is improper unbundling, and the facility's name is on the resident record either way.
Billing under the facility's own NPI puts the facility in control. You own the documentation, you control every claim that goes out, and you can find and fix a pattern before a MAC or a RAC does.
Side-by-Side Comparison
| Supplier-billed | Facility-NPI | |
|---|---|---|
| Billing NPI | Supplier's NPI | Facility's NPI |
| Who receives Medicare payment | The supplier | The facility |
| Facility Part B supply revenue | $0 | Full allowed amount on covered claims |
| Control over claim documentation | With the supplier | With the facility |
| Audit exposure | Facility carries the resident record without controlling the claim | Facility controls the record and the claim |
| Setup required | None, usually bundled into the supply contract | Documentation workflow, coding, and claim submission under the facility NPI |
What Facility-NPI Billing Requires
Facility-NPI billing needs a billing partner who understands Part B mechanics in this setting. Burst Billing is an independent Part B billing partner working exclusively with skilled nursing facilities. We bill under the facility's NPI, build the claims, manage the documentation, handle audit correspondence, and submit to the A/B MAC.
The model is contingency-only: no fee without recovered revenue. Our PointClickCare integration is read-only. We bill five categories, surgical dressings, ostomy, urological, tracheostomy, and splints and orthotics, and we do not bill durable medical equipment. Enteral nutrition is billed for Medicare Advantage residents only. Burst is active in 16 states and a PointClickCare Marketplace Partner.
The assessment is free, takes 30 minutes, and ends with written findings. No pitch.
Written by
Eric Hansen
Founder, Burst Billing
Eric Hansen is the founder of Burst Billing, with 15 years in long-term care across both the provider and vendor sides. He helps skilled nursing facilities recover missed Medicare Part B supply reimbursement through cleaner documentation, tighter vendor workflows, and contingency-based billing reviews.
More from Eric →Frequently asked questions
- The difference is which NPI appears as the billing provider on the claim. Under the supplier-billed model, an outside supply vendor submits the claim under its own NPI and Medicare pays the supplier. Under the facility-NPI model, the skilled nursing facility submits the claim under its own NPI and Medicare pays the facility. The supply, the resident, and the clinical documentation can be identical in both cases.
- Yes. For residents who are not in a covered Part A stay, a skilled nursing facility can bill its A/B MAC under its own NPI for surgical dressings, ostomy, urological, tracheostomy, and splint and orthotic supplies. An enrolled supplier billing the DME MAC is the alternative pathway. Both are permitted; only one of them pays the facility.
- The billing NPI tells CMS who to pay. It is the field that determines whether Part B supply reimbursement lands with the facility or with an outside supplier, regardless of who ordered, delivered, or documented the supply.
- CRUSH stands for Comprehensive Regulations to Uncover Suspicious Healthcare. CMS launched it in February 2026 with DMEPOS suppliers as a primary target, and reports it stopped $1.5 billion in suspected fraudulent DMEPOS billings in 2025. Supplier claims submitted for residents during covered Part A stays are the unbundling pattern the initiative put under scrutiny.
- Burst Billing is an independent Part B billing partner working exclusively with skilled nursing facilities. Claims are billed under the facility's own NPI, so reimbursement goes to the facility. Burst builds the claims, manages the documentation, handles audit correspondence, and submits to the A/B MAC on a contingency-only basis, with a read-only PointClickCare integration.
- Yes, when the underlying rules are followed. Billing mechanics for SNF Part B claims are set out in CMS Pub. 100-04, Chapter 7. A compliant claim needs a Standard Written Order, medical necessity documentation tied to a covered diagnosis, proof of delivery, and HCPCS coding matched to the applicable Local Coverage Determination, for a resident who is not in a covered Part A stay.
Continue exploring
See what your facility may be missing
No upfront cost · No recovery, no fee