Medicare Audit Defense Case Study
By the numbers
The typical trigger
A SNF receives a TPE, RAC, UPIC, or MAC pre-pay request on Part B supply claims, often in categories such as urological or surgical dressing codes. Without a pre-built audit packet, the response burden falls back on the business office under a tight clock.
How Burst supports the response
For claims Burst billed, our team assembles the supporting documentation, Standard Written Order, certification of medical necessity (where applicable), clinical note, and proof of delivery, and prepares the response narrative for the facility to review and submit.
What outcomes look like
Outcomes depend on the underlying clinical documentation, payer rules, and the auditor's determination. Burst does not guarantee audit success. Documentation-focused billing support is included in our service at no additional cost on claims we billed.
Frequently asked questions
- A routine Targeted Probe and Educate cycle on a supply code family, not a suspicion of wrongdoing. TPE is an education-first program and most facilities encounter it eventually.
- Every claim traced to a dated clinical encounter with an order, a wound or care note, and evidence of the item furnished, all created at the time of care rather than assembled during the review.
- Unsupported claims are denied and recouped, and a poor first TPE round leads to a second and third round of review. The defense is built before the letter arrives, not after.
Related insights
How to Maintain Audit Readiness While Recovering Missed Revenue
Learn how SNFs can recover missed revenue while staying audit-ready with documentation-first billing review, resident status checks, and clear reporting.
Read articleHow to Prepare for a Medicare Billing Audit in a Skilled Nursing Facility
Learn how SNFs prepare for a Medicare billing audit with a one-claim diagnostic test, a documentation gap review, and a repeatable 30-day readiness cycle.
Read articleWhat Your PointClickCare Data Is Already Telling You About Part B Billing Gaps
Learn how SNFs use PointClickCare data to surface missed Medicare Part B billing, from data signals to exclusion tracking and monthly reporting.
Read article“They made something that felt risky actually feel very controlled and legitimate.”
Reviewed by Cara Hansen, Chief Operating Officer · July 2026. Review timeline and documentation packet contents reflect the actual response filed in this engagement.
Turn Missed Opportunities Into Real Profit.
Request a Part B reimbursement review for your skilled nursing facility. No added work for your staff. No upfront cost. No obligation.
"*" indicates required fields
Risk-free. If you don't get paid, neither do we.