Responding to a Medicare Part B Supply Documentation Request at an SNF
The assessment reviews your facility's current Part B supply arrangement and potential eligibility. It does not guarantee reimbursement.
What triggered the review
In this example, the trigger is a single additional documentation request (ADR) from the facility's Medicare Administrative Contractor (MAC) on a small set of surgical dressing claims billed under the facility's NPI. It is one request of one type. It is not a Targeted Probe and Educate (TPE) review, a Recovery Audit Contractor (RAC) audit or a Unified Program Integrity Contractor (UPIC) review, which are separate programs with their own purposes and procedures. CMS notes that most providers will never need TPE.
What the request required
The letter lists the claims, the records requested and the response deadline. For each dressing claim, that typically means the order, the clinical records describing the wound and its measurements, proof of delivery, and the supply-use record showing which dressings were furnished and when. Documentation must support the claim from the underlying care and supply record. Missing orders, clinical events or delivery records cannot be reconstructed after the notice, and nothing is created or back-dated.
What Burst assembled
On claims Burst billed, Burst locates the records that already exist for each claim, organizes them into one packet per claim in the order the request lists them, and drafts a short cover summary pointing the reviewer to where each requirement under the applicable LCD is met. Where a record is incomplete, the packet says so plainly rather than filling the gap. See documentation requirements for how records are kept claim-ready.
What the facility was responsible for
The facility is the billing provider and stays responsible for the response. In this example, the facility forwards the request to Burst when it arrives, and its clinical and business office leads review the packet and confirm it matches their records. The exact split of review and submission steps is agreed with each facility.
Deadline and submission
The deadline is set by the contractor, not by Burst. Burst tracks it and flags anything unanswered well before it, and the response is submitted before the deadline. Submitting on time does not guarantee any outcome.
Documented outcome
Because this is an illustrative example, there is no determination to report. What it shows is a decision rule: the strongest response is a claim that was only billed because its record already supported it. That is why Burst screens resident status, coverage and documentation before Part B supply billing, and holds or excludes claims the record does not support. Burst's support on claims it billed is described on the audit defense page. Back to case studies
Frequently asked questions
- They are separate programs. Targeted Probe and Educate (TPE) is run by Medicare Administrative Contractors and pairs claim review with one-on-one education to correct errors. Recovery Audit Contractors (RAC) review paid claims to identify improper payments. They are not interchangeable. CMS explains TPE on its Targeted Probe and Educate page.
- No. CMS states that most providers will never need TPE. It is used for providers identified through data analysis as having high claim error rates or unusual billing patterns.
- No. Documentation must support the claim from the underlying care and supply record created at the time of care. Missing orders, clinical events or delivery records cannot be reconstructed after the notice.
- A denied claim can be appealed through the standard Medicare appeals process, starting with a redetermination request to the contractor, where the facility decides an appeal is appropriate. Further levels exist, but none is automatic; each has its own deadline and must be requested.
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Read articleRequest a Part B Supply Billing Assessment
The assessment reviews your facility's current Part B supply arrangement and potential eligibility. It does not guarantee reimbursement. Please do not submit PHI through this form.
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