Supplier-Billed vs. Facility-NPI Medicare Part B Billing for SNFs

The money exists. The question is who gets it.

Medicare Part B covers five categories of supplies delivered to your residents: surgical dressings, ostomy, urological, tracheostomy, and splints/orthotics. Facilities have had the authority to bill for those supplies directly for decades, and the consolidated billing rules that decide who bills for what have been law since 1997. And yet, in skilled nursing facilities across the country, that reimbursement is landing in someone else's account.

The reason comes down to one field on the claim: the billing NPI.

How Medicare Part B Supply Billing Actually Works

Every Part B claim filed with CMS requires a billing NPI. That National Provider Identifier tells Medicare who to pay.

Two parties can occupy that field for supply claims in a SNF setting. An outside supplier can file under its own NPI. Or the facility can file under its own NPI instead. This dual pathway exists for residents in a non-covered stay. Under the SNF consolidated billing rules established by the Balanced Budget Act of 1997, only therapy services stay bundled for those residents. Every other covered category, including these five supply categories, can be billed separately.

The practical difference: when a supplier's NPI appears on the claim, Medicare pays the supplier. When the facility's NPI appears on the claim, Medicare pays the facility.

Everything else in this post is detail around that one fact.

The Supplier-Billed Model

External Part B suppliers bring supplies into facilities and bill CMS under their own NPI. The supplies arrive. The claim gets filed. The facility sees nothing.

This became the default because most facilities adopted the supplier relationship before understanding they had a direct billing option. Suppliers built their revenue model around it. Facilities never questioned an arrangement that felt like someone else handling something complicated.

From the facility's financial perspective, the supplier-billed model produces one consistent result: $0 in Part B supply revenue, regardless of how many residents are on wound care, catheters, or ostomy supplies.

The compliance dimension compounds that. CMS's CRUSH initiative, Comprehensive Regulations to Uncover Suspicious Healthcare, launched in February 2026 with DMEPOS suppliers as a primary target. CMS reports it stopped $1.5 billion in suspected fraudulent DMEPOS billings in 2025. When an outside supplier bills separately for supplies that belonged in a facility's bundled payment, that unbundling is a pattern auditors know how to find.

The Facility-NPI Model

When a facility bills Part B supplies under its own NPI, the claim structure changes and so does who gets paid.

Under this model, the facility is the billing entity. CMS cross-references the facility's NPI against the resident's Part B coverage and, when documentation requirements are met, issues reimbursement directly to the facility. CMS Pub. 100-04, Chapter 7 governs the billing mechanics.

What the facility needs to file a valid claim: a Standard Written Order documenting medical necessity, in hand before the claim is filed; diagnosis-tied medical necessity documentation in the resident's record; proof of delivery; accurate HCPCS coding matched to the applicable Local Coverage Determination.

These requirements exist whether a supplier bills or the facility bills. The difference is whether the facility sees the check.

The Compliance Case for Facility-NPI Billing

The supplier-billed model creates a structural compliance exposure that most facilities don't recognize until an audit lands on their desk.

Under Medicare's consolidated billing rules, SNFs carry responsibility for the Medicare services their residents receive. During a covered Part A stay, those supplies are the facility's billing responsibility, and a supplier claim filed separately is improper unbundling on a resident the facility is accountable for. If the supplier's documentation doesn't hold up in a post-payment review, the audit activity lands on the facility's residents and the facility's building.

Facilities billing under their own NPI own the documentation. They control what goes into every claim. They can fix problems before a MAC or RAC finds them. That's a compliance argument, not just a revenue argument.

Side-by-Side Comparison

What Facility-NPI Billing Requires

Moving to facility-NPI billing requires a billing partner who understands Part B mechanics. Most facility billing teams haven't done this, because most facilities haven't done this.

Burst Billing is an independent Part B billing partner that works exclusively with skilled nursing facilities. We bill under the facility's NPI. We build the claims, manage documentation, handle audit correspondence, and submit to the A/B MAC. Medicare pays the facility directly. Burst's contingency fee comes off what's actually collected.

Our model is contingency-only. No recovered revenue, no fee. The facility carries no financial risk.

We integrate with PointClickCare in read-only mode. No workflow changes, no staff training required.

The five categories we bill: surgical dressings, ostomy, urological, tracheostomy, and splints/orthotics. We don't bill DME. Enteral nutrition billing is available for Medicare Advantage residents. We're active in 16 states and are a PointClickCare Marketplace Partner.

If your facility is currently working with a supplier billing under their NPI, you're not collecting the Part B supply revenue your residents generate. That revenue is real. The legal pathway has been there for decades.