What a 12-Month Part B Supply Billing Review Covers at an SNF
The assessment reviews your facility's current Part B supply arrangement and potential eligibility. It does not guarantee reimbursement.
The facility's starting situation
In this example, the facility bills Part A and Medicaid well, but Part B supplies furnished to residents outside a covered Part A stay are billed by an outside supplier under the supplier's own NPI, or not billed at all. The business office has no routine way to see which of those supplies could be billed under the facility's NPI. No specific facility is described.
What the lookback actually reviews
The lookback covers dates of service in the previous 12 months, because Medicare generally requires claims to be filed within one calendar year of the date of service. Burst reviews physician or practitioner orders, resident stay status, coverage under the applicable rules, the clinical documentation supporting need (for example wound measurements or ostomy care notes), prior billing by the facility or a supplier, and payer rules. A 12-month review does not mean every supply furnished during those 12 months can be billed. Date of service, timely filing, resident status, coverage, documentation, and prior billing are each checked.
How claims are screened
Every potential claim goes through four checks before it is prepared: - Resident stay status: was the resident in a covered Part A stay on that date? If so, consolidated billing bundles most supplies into the Part A payment and the item is excluded. - Coverage: does the item fall in a covered category and meet the applicable Local Coverage Determination (LCD)? - Documentation: is there an order, a contemporaneous clinical note supporting need, and a record that the item was furnished? - Billing pathway: is the resident on Original Medicare or a Medicare Advantage plan, is the date inside the filing window, and was the item already billed? The results are kept separate on purpose: - Identified: items that look potentially eligible from the records. This is an estimate of opportunity, not collected reimbursement. - Excluded: items that fail a rule, such as a Part A date, an expired filing window or prior billing. - Held: items missing something that should already exist in the record. Nothing is created after the fact. - Submitted: only items that pass every check. - Approved, paid or denied: what Medicare decides after submission. Only paid claims are revenue. The Medicare Part B supply list for SNFs shows the categories and coverage rules used in this screen.
Who does what
The facility grants read-only record access, through PointClickCare where the facility uses it, confirms orders and clinical documentation, answers questions on held items, and remains the billing provider responsible for its claims. Burst reviews the records, screens each potential claim, prepares and submits claims under the facility's NPI, reconciles payments claim by claim, and works denials. The existing supplier arrangement is not necessarily changed. What shifts is billing ownership: eligible claims are billed under the facility's NPI. See Part B supply reimbursement for how that works.
What this example demonstrates
Because this is an illustrative example, there are no results to report. It shows a decision rule: a claim is submitted only when the resident's status, the coverage rule and the underlying record all support it. Anything unsupported is held or excluded rather than billed.
What another SNF should know
If your facility furnishes surgical dressings, ostomy, urological, tracheostomy or splint and orthotic supplies to residents outside a covered Part A stay, a lookback can show which of those items your records may support. Eligibility and payment outcomes vary by facility, payer, and documentation. Burst's fee is a percentage of Medicare payments actually received, as explained on the contingency billing page. Back to case studies
Frequently asked questions
- No. Eligibility depends on documentation, resident status, coverage and payer rules for each claim, and Medicare makes its own payment decision on every claim submitted.
- Not necessarily. Burst bills eligible claims under the facility's NPI; how supplies are purchased and delivered varies by facility, and that decision stays with the facility.
- They are held or excluded, not submitted. Held items go back to the facility to check against records that should already exist; nothing is created after the fact.
Related insights
When Compliance and Revenue Recovery Run Separately, SNFs Pay Twice
A documentation-first review process connects compliance and revenue recovery in SNFs: decision status framework, monthly checklist, and leadership visibility.
Read articleHow 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 article12-Month Medicare Part B Lookback for SNFs: What Can Still Be Billed?
SNFs have 12 months to file Part B supply claims that were never submitted. Under 42 CFR 424.44, what qualifies and how to run the lookback.
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.
"*" indicates required fields
Risk-free. If you don't get paid, neither do we.