Your supplier has been billing Medicare for your residents' supplies for years. The check goes to them.
“Before using Burst, we partnered with a medical supply company who would bill Part B plans as the provider and keep the revenue for themselves. Burst not only met but exceeded our expectations. They've helped us recover revenue we would otherwise have left on the table.”
“Burst delivered a 55% ROI on wound supplies across my skilled nursing facilities in eight months. The model works.”
“The speed at which we started seeing results was impressive. It showed up quickly and created an immediate financial lift.”
Why facilities choose Burst
The reimbursement comes back to you
You're the legal billing entity. Medicare pays your facility directly. Burst operates as your billing arm — we submit under your NPI, to your MAC, against your residents' clinical records.
Conservative claims that hold up under review
Human compliance QA on every claim before it goes to the MAC. If the chart doesn't support it, we don't submit it. A pre-built audit packet goes out with every claim we send.
Your supply chain stays exactly as it is
Burst only bills. Your supplier relationships, your pricing, your product choices — none of it moves.
You pay nothing until Medicare pays you
Contingency only. If a claim is denied and the appeal fails, Burst eats it. You owe nothing.
What you're currently missing
Most SNFs leave $1,200 to $4,000 per month on the table — per facility — because a supplier is collecting Medicare Part B reimbursements that belong to the facility. The supplies are already in your residents' rooms. The clinical documentation is already in your EHR. The reimbursement entitlement exists under 42 U.S.C. § 1395x(s)(8). What's missing is someone submitting the claim under your NPI instead of the supplier's. That's the entire problem. And it's what Burst fixes.
What we recover
Wound care dressings, urological and catheter supplies, ostomy supplies, enteral nutrition, tracheostomy supplies. Every claim is mapped to HCPCS codes — A4253, A4351, A6196, B4035, and others — and tied to clinical documentation already in your EHR. We bill only the five categories explicitly authorized under CMS policy for SNF institutional NPI billing. Nothing outside those five categories gets submitted.
How it's billed
Claims go out under your facility's NPI to the appropriate A/B MAC. You retain full ownership of the CMS relationship. ERAs land in your account. Burst handles HCPCS and CPT code mapping, LCD validation, modifier application (KX, GA, RT/LT), claim scrubbing, ERA reconciliation, denial management, and appeals. Burst operates in all MAC jurisdictions across all 50 states.
The compliance picture
CMS's CRUSH initiative is actively targeting external suppliers who bill Medicare Part B under their own NPI with no verifiable connection to the patient's clinical record. That's the standard supplier arrangement most SNFs currently rely on. Burst submitted a formal public comment to CMS in 2026 proposing facility-side billing as the structural solution. Billing under your facility's NPI, tied to your clinical record, is what CMS is asking for. It's also how Burst works.
Read the public commentWhat's included
- HCPCS / CPT code mapping for every Part B-eligible supply
- LCD validation against your MAC's local coverage policy
- Modifier application (KX, GA, RT/LT, etc.)
- Claim scrubbing and MAC submission
- ERA reconciliation and denial workflow
- Appeals on every denied Part B supply claim
- Monthly claim-level reporting
- Audit packet pre-built for every submitted claim
How it works
4 steps · risk-free- 101 / 04
Free reimbursement assessment
Share anonymized utilization data. We model recoverable Part B supply revenue specific to your facility — no cost, no commitment. Most facilities see their number within 30 minutes.
- 202 / 04
PointClickCare integration
Read-only Marketplace connection. BAA executed. Live in under two weeks.
- 303 / 04
Claims begin
We bill under your NPI to your MAC. ERAs land in your account. Burst is paid a percentage of collected revenue only after CMS pays you.
- 404 / 04
Audit-ready from day one
Every claim ships with a pre-built audit packet. If a TPE, RAC, UPIC, or MAC review lands, our team supports the response at no additional cost.
Burst vs. an outside supplier
How Burst handles compliance — and what that means for your facility
The most common reason facilities delay is compliance concern, not revenue concern. Below is the complete regulatory framework governing Part B supply billing in SNFs. This is the same framework Burst operates under on every claim we submit.
The legal basis in plain terms
What the law actually says
Medicare Part B coverage for SNF supply billing rests on a straightforward statutory foundation. Section 1861(s) of the Social Security Act — codified at 42 U.S.C. § 1395x(s) — expressly defines and authorizes each supply category Burst bills:
- § 1395x(s)(5)Surgical dressings, splints, casts, and fracture/dislocation devices
- § 1395x(s)(8)Prosthetic devices replacing internal body organ function, including ostomy, urological, and tracheostomy supplies
- § 1395x(s)(9)Leg, arm, back, and neck braces
- § 1395x(s)(2)(D)Enteral and parenteral nutritional therapy for patients with permanent impairment requiring tube feeding
CMS operationalizes this authority in Medicare Claims Processing Manual, Pub. 100-04, Ch. 7, §§ 10 and 60, which authorize SNFs to bill the A/B MAC directly using the institutional NPI on a UB-04 (Form CMS-1450) for residents without an active Part A stay.
The single most important distinction — POS vs. DME
Why these supplies are not DME
The most common compliance misconception is that the supplies Burst bills are Durable Medical Equipment. They are not. This distinction determines the entire billing pathway.
Prosthetic and Orthotic Supplies (POS)
- Statutory basis
- 42 U.S.C. § 1395x(s)(8) and (9)
- Definition
- Devices that replace the function of a missing or permanently impaired body part or organ
- Examples
- Ostomy pouches, urological catheters for permanent urinary incontinence, tracheostomy care supplies, surgical dressings for qualifying wounds, orthotic braces
- Billing route
- A/B MAC (A), UB-04, bill type 22X, institutional NPI
Durable Medical Equipment (DME)
- Statutory basis
- 42 U.S.C. § 1395x(n)
- Definition
- Equipment that can withstand repeated use, primarily serves a medical purpose, and is generally appropriate for use in the home
- Examples
- Wheelchairs, hospital beds, oxygen concentrators, CPAP machines, walkers
- Billing route
- DME MAC, separate National Supplier Clearinghouse enrollment required
An ostomy pouch is not equipment — it is a prosthetic device replacing the function of a resected bowel. A catheter for a patient with permanent urinary incontinence is not equipment — it is a prosthetic device replacing normal bladder function. The statutory classification controls the billing pathway entirely.
When Part B billing is and isn't permitted
The bright-line rule
The boundary between consolidated billing and permissible Part B carve-outs is determined entirely by one factor: whether the resident has an active covered Medicare Part A stay.
| Situation | Rule | Burst's action |
|---|---|---|
| Resident has active Part A stay | Consolidated billing applies. No separate Part B claim permitted. | Burst does not submit a claim. |
| No active Part A stay | Separate Part B billing authorized for qualifying supply categories. | Burst stages the claim for submission. |
| Supply is a prosthetic device or surgical dressing | SNF bills A/B MAC (A) on UB-04, bill type 22X, institutional NPI. | Burst submits under your NPI. |
| Supply is DME | Cannot be billed under institutional NPI. DME MAC enrollment required. | Burst excludes it at intake. |
| SWO, medical record, and proof of delivery are complete | Claim is billable. Documentation retained 7 years per 42 C.F.R. § 424.57(c)(12). | Burst submits the claim. |
| Documentation is incomplete or missing | Claim is not billable. | Burst does not submit the claim. We wait until documentation is complete. |
| Resident is dual-eligible (Medicare + Medicaid) | Must confirm supply is not already covered under Medicaid per diem rate. Duplicate billing is impermissible. | Burst confirms payer status before staging any claim. |
What documentation is required
Four universal requirements — every claim, no exceptions
Per CMS Policy Article A55426, these four elements are required for every claim and must be retained for seven years from the date of service per 42 C.F.R. § 424.57(c)(12):
Standard Written Order (SWO)
A written order communicated to the supplier by the treating practitioner before claim submission. Must include: beneficiary name or MBI, order date, item description, quantity if applicable, and the treating practitioner's name or NPI with original signature. Signature stamps are not permitted.
Medical Record Documentation
Contemporaneous clinical documentation sufficient to establish that the item meets the reasonable and necessary criteria in the applicable LCD. Must support the type, quantity, and frequency of items ordered.
Proof of Delivery (POD)
Documentation confirming supplies were delivered to the facility and received by or on behalf of the beneficiary. Suppliers and their employees may not sign as a designee on the beneficiary's behalf. Retained seven years per 42 C.F.R. § 424.57(c)(12).
Refill Documentation
For recurring supplies, an affirmative confirmation from the beneficiary or caregiver documenting continued need — before the refill ships. Automatic shipments on a pre-set schedule are not permitted. Retrospective documentation is not acceptable.
Category-specific LCD requirements
What each supply category requires
Each supply category is governed by its own Local Coverage Determination. Burst validates against these before any claim is submitted.
| Supply category | Governing LCD | Key quantity limits | Additional requirement |
|---|---|---|---|
| Surgical dressings | L33831; Policy Article A54563 | Clinically determined by wound type and dressing change frequency | Monthly wound evaluation required; qualifying surgical procedure or debridement must be documented |
| Ostomy supplies | L33828 | Per-code monthly or six-month maximums specified in LCD; no more than one-month supply at a time for nursing facility residents | Liquid barriers: use either spray/liquid (A4369) or wipes (A5120), not both concurrently |
| Urological supplies | L33803 | One catheter per month for routine maintenance; up to 200 units/month for intermittent catheterization; three-month supply limit | Specialty catheters (A4340, A4344) require documented clinical indication; external catheters denied if indwelling catheter also in use |
| Tracheostomy supplies | L33832 | Per-code monthly maximums specified in LCD; no more than one-month supply at a time for nursing facility residents | Tracheostomy care kit (A4625) not covered after two weeks post-operatively |
| Enteral nutrition | L38955 | Governed by MA plan contract where applicable | Burst does not bill enteral nutrition to traditional Medicare; billed to Medicare Advantage plans under contracted arrangements only |
| Prosthetic and orthotic devices | Pub. 100-04, Ch. 7, § 60 | Per LCD by device type | Revenue Code 274, bill type 22X |
How Burst audits its own claims
Built-in compliance checks — before and after submission
Burst's pre-submission review confirms six things before any claim goes to the MAC:
- 01Payer status verified — no active Part A stay on the date of service
- 02Supply correctly classified as POS, not DME
- 03SWO complete with original practitioner signature and correct revenue code
- 04Medical record documentation satisfies the applicable LCD's reasonable and necessary criteria
- 05Proof of delivery on file matching the billed quantity
- 06For recurring supplies: documented affirmative refill request prior to dispensing
If an audit identifies a claim for which payment was received but was not owed, Burst reports and returns the overpayment within 60 days, consistent with 42 U.S.C. § 1320a-7k(d). This is not optional — it is a federal requirement, and Burst treats it as one.
This framework is built to the OIG Compliance Program Guidance for Nursing Facilities.
Download the full compliance brief
The complete regulatory framework — for your compliance team
The document below covers the full statutory and manual authority, the consolidated billing boundary, category-specific documentation requirements, and a six-step sample compliance policy framework your team can adopt directly. Used by compliance officers, DONs, CFOs, and legal counsel at facilities across 16 states.
A seven-step policy your compliance team can adopt
Built to the OIG Compliance Program Guidance for Nursing Facilities. The following provides a compliant, standardized process for billing Medicare Part B for eligible medical supplies — the same process Burst follows on every claim.
Payer Status Verification
Before any claim is staged, verify and document that the resident was not in a Medicare Part A-covered stay on the date of service. Verification must be contemporaneous — retroactive payer status determinations are not sufficient. For dual-eligible residents, additionally confirm the supply is not already covered under the Medicaid nursing facility per diem rate.
Supply Classification
Confirm the ordered supply falls within a permissible Part B carve-out category and is not classified as DME. Confirm the applicable HCPCS code corresponds to the correct revenue code: Revenue Code 274 for prosthetic and orthotic devices; Revenue Code 623 for surgical dressings (A6000-series).
Standard Written Order and ABN
No claim may be submitted without a completed SWO on file, communicated prior to delivery. For items requiring a Written Order Prior to Delivery (WOPD), the signed SWO must be received before the item is delivered. If Medicare payment is expected to be denied, confirm a valid Advance Beneficiary Notice of Non-coverage (ABN, Form CMS-R-131) was issued to and signed by the beneficiary before delivery.
Medical Necessity Review
Review the medical record to verify the presence of contemporaneous clinical documentation sufficient to satisfy the applicable LCD's reasonable and necessary criteria. This is a documentation verification function — staff confirm that required documentation is present and complete; they do not make independent clinical medical necessity determinations.
Proof of Delivery Verification
Verify that POD documentation is on file confirming supplies were delivered to the facility and received by or on behalf of the beneficiary. Quantities delivered and used must justify the quantity billed. Suppliers and their employees may not sign as a designee on the beneficiary's behalf. Retained seven years per 42 C.F.R. § 424.57(c)(12).
Refill Protocol
No refill may be dispensed or billed without a documented affirmative response from the beneficiary or caregiver confirming continued need. Automatic shipments on a pre-set schedule are not permitted. Contact for refill purposes must occur no sooner than 30 calendar days prior to the expected end of the current supply. Delivery must occur no sooner than 10 calendar days prior to the expected end. Setting-specific dispensing limits apply: one month at a time for ostomy and tracheostomy; three months at a time for urological supplies.
Auditing and Monitoring
Conduct quarterly audits of a random sample of Part B supply claims, reviewing for: (1) documented payer status verification on the date of service; (2) correct supply classification and revenue code assignment; (3) a complete, timely SWO with original practitioner signature; (4) medical record documentation sufficient to satisfy the applicable LCD; (5) proof of delivery matched to the billed quantity; and (6) for recurring supplies, a documented refill request prior to dispensing. If an audit identifies a claim for which payment was received but was not owed, report and return the overpayment within 60 days per 42 U.S.C. § 1320a-7k(d).
Supply categories we recover for SNFs
Related
Questions we hear from every operator
Operators who switched to Burst — in their own words.
“Before using Burst Billing, we partnered with a medical supply company who would bill Part B plans as the provider and keep the revenue for themselves. Burst Billing not only met but exceeded our expectations and truly opened our eyes to the benefits of a revenue share model. From the transparency and confidence of their leadership to the expertise of their billers, working with Burst Billing has been an overwhelmingly positive experience. They've helped us recover revenue we would otherwise have left on the table.”
“The speed at which we started seeing results was impressive. We didn't have to wait months to understand the value — it showed up quickly and created an immediate financial lift.”
“This is one of the few initiatives where the ROI is obvious.”
Verified operator · 5–10 facility groupReal client · Verifiable · Reference available on request“They feel more like a partner than a vendor — hard to replicate internally.”
Verified operator · 10+ facility groupReal client · Verifiable · Reference available on request“They made something that felt risky actually feel very controlled and legitimate.”
Verified operator · 10+ facility groupReal client · Verifiable · Reference available on request“Low effort, high impact — and it scales without adding internal burden.”
Verified operator · 20+ location groupReal client · Verifiable · Reference available on requestEvery testimonial is from a real, verifiable Burst client. In senior care, most operators prefer not to be named publicly — but prospective clients can request a reference call during their assessment.
“As a COO, I rely on partners who bring clarity, consistency, and real operational impact. Burst Medical is responsive, knowledgeable, and genuinely invested in driving results for our centers.”
“All SNF operators should use Burst to collect on their Part B supplies. They work hard and efficiently to recover revenue that is left on the table — easy to work with, responsive, and a trusted long-term partner.”
ROI on wound supplies
“Burst delivered a 55% ROI on wound supplies across my Skilled Nursing Facilities in eight months. The model works.”
Chris Laymon · VP of Operations / PurchasingSee what your facility is missing
We'll model exactly what your facility left uncollected — using your supply utilization data, your MAC's fee schedule, and your case mix. You'll have a number before the call ends. No upfront cost. No commitment. No fee if we don't recover.
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Information on this website is for general business purposes only and does not guarantee reimbursement, claim approval, or audit outcomes. Results may vary based on facility documentation, resident eligibility, payer rules, and applicable Medicare requirements.