Medicare Audit Defense for SNFs
What to know in 60 seconds
- Audit packets are assembled before submission, not after a record request, so the response window starts from a prepared file, not a scramble.
- Burst supports TPE, RAC, UPIC, and MAC pre- and post-pay reviews on claims we submit, at no additional cost.
- We bill only what your clinical record supports. When documentation is incomplete, the claim is held until it isn't.
- Documented overpayments are reported and returned within 60 days, consistent with 42 U.S.C. § 1320a-7k(d).
Why facilities choose Burst
Pre-built audit packets
Physician order, certification of medical necessity, clinical note, and proof of delivery, assembled before the claim is submitted, not after the audit lands.
Documentation discipline
We bill only what your clinical record supports. If the documentation isn't there, the claim doesn't go out.
Audit response included
TPE rounds, RAC requests, MAC pre-pay reviews, we draft the response, you submit it. No additional cost on claims we billed.
Documentation discipline
We bill only what your clinical record supports. Every line item is backed by a physician order, a signed certification when required (DME 6-month rule, oxygen, enteral, etc.), and proof of delivery. The audit packet is pre-built.
Audit response support
If a record request arrives, we pull the supporting documentation, draft the response narrative, and return it to your facility for review and submission. We've responded to TPE rounds, RAC requests, and MAC pre-pay reviews on Part B supply claims since 2018.
The four review types SNFs actually see, and how each one behaves
Targeted Probe and Educate (TPE) is a MAC-run, education-first process: a small sample of claims, a written result, and up to three rounds before escalation. RAC reviews are contingency-paid contractor audits that typically look backward at paid claims and focus on patterns rather than single lines. UPIC reviews are program-integrity driven, broader in scope, and are the one category where a facility should involve counsel early. MAC pre-payment review is the most operationally disruptive because claims stop paying while records are reviewed, which turns a documentation problem into a cash-flow problem within a single cycle. The response strategy differs for each: TPE rewards fast, complete, well-organized submissions; pre-pay review rewards prevention, because by the time it starts the remedy is already behind you.
What a complete Part B supply audit packet contains
For a supply line to survive review, the record has to answer four questions without interpretation: who ordered it, why it was medically necessary, that the resident received it, and when. In practice that means a dated physician order tied to the specific item, a signed certification of medical necessity where the item category requires one, a clinical note that establishes the condition supporting the LCD criteria, and proof of delivery at the point of dispense. Missing any one of them makes an otherwise legitimate claim indefensible. Because we assemble this set before submission rather than after a request, a record request becomes a retrieval task with a known answer instead of a two-week hunt across nursing, purchasing, and the medical director's office.
Response timelines and who does what when a request lands
Most Additional Documentation Requests give 30 to 45 days, and the clock starts at the letter date, not the day it reaches the right desk. Our process: you forward the request, we identify every claim in scope, pull the pre-built packet for each, draft the response narrative that maps the documentation to the reviewer's stated criteria, and return the assembled file to your facility for review and submission. Your team signs and submits — we never submit on your behalf, because the claim is yours. If the result is partially unfavorable, we prepare the redetermination at the same no-additional-cost terms, and we tell you plainly when a line should be conceded rather than appealed.
When we hold a claim, and why that is the point
The most valuable thing an audit-defense posture does is stop bad claims from going out. If documentation for a supply line is incomplete, the line is held and returned to the facility with the specific missing element named, rather than billed on the assumption that most claims are never reviewed. This lowers short-term billed volume and we are direct with clients about that trade. It also means that when a review does arrive, the sample is drawn from a population that was built to be reviewed. If a documented overpayment is ever identified, it is reported and returned within 60 days, consistent with 42 U.S.C. § 1320a-7k(d); our compliance framework covers the controls behind that commitment.
Audit posture: Burst-submitted vs typical Part B claim
Frequently asked questions
- Forward it to us. We assemble the documentation packet for the requested claims from your record, review it against the coverage criteria the reviewer will apply, and return it to the facility for submission within the response window.
- The facility is the responding provider. We prepare and support the response, including the narrative and the record set, but the submission stays under facility control and every document is one your clinicians created.
- We review the denial rationale, pursue redetermination where the record supports it, and drop the claim where it does not. Denied claims generate no fee, so there is no incentive to defend a claim that should not have been billed.
Audit response and documentation briefs
Medicare Part B Compliance for SNFs: What to Watch
Review Medicare Part B compliance watchpoints for SNFs: resident status, documentation, coding, vendor visibility, denials, and audit-ready files.
Read articleMedicare Part B Supply Billing Documentation: What SNFs Need
The record behind a Medicare Part B supply claim passes through five departments. What SNFs need, who holds each piece, and how to close the gap.
Read article“They made something that felt risky actually feel very controlled and legitimate.”
Reviewed by Cara Hansen, Chief Operating Officer · August 2026. Audit-response steps were reviewed against current ADR and Targeted Probe and Educate response requirements.
Review your Part B audit posture
Describe the review notice or documentation concern—not resident details. We’ll explain which records belong in the response path and where facility or legal review is required.
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