Medicare Part B supply reimbursement for skilled nursing facilities
A short call about your facilities, your PointClickCare setup, and what Part B could mean for you. No patient info needed.
- Medicare Part B lets your SNF bill for four kinds of supplies (surgical dressings, ostomy, urological, and trach) when your residents are not on a Part A stay. We don't bill regular Medicare for enteral nutrition.
- We send those claims in your facility's name, using your resident charts. Your main medical supplier stays. You drop the outside Part B supplier, so you control what you buy and you keep the money Medicare pays.
- We only get paid when you do. No setup fee. No monthly minimum. You pay a small share of what Medicare actually pays your facility.
- We check every claim against Medicare's rules and build a full audit packet for it (order, chart notes, proof of delivery). If Medicare ever audits one of our claims, we handle it for free.
Qualification
Does my skilled nursing facility qualify?
Burst works exclusively with skilled nursing facilities using PointClickCare. There is no minimum facility count, census, or claim-volume requirement.
Answer five quick questions to see whether your facility fits. No PHI required.
- Your organization operates one or more skilled nursing facilities.
- Your facility uses PointClickCare.
- You care for residents who are not currently in an active covered Medicare Part A stay.
- Your facility uses eligible Part B supply categories such as surgical dressings, ostomy, urological, or tracheostomy supplies.
- The resident's clinical record can support the claim with the required order, medical documentation, proof of delivery, and refill documentation when applicable.
60-second check
Question 1 of 5
Step 1 of 5
Do you operate an SNF?
Right now your supplier gets paid. With Burst, you do.
Today, your outside supplier bills Medicare in their name and keeps the money. With Burst, the same supplies get billed in your facility's name, and Medicare pays you.
Today: outside supplier
- Your resident gets their supplies
- Your outside supplier bills Medicare in their own name
- Supplier keeps the moneyThe supplier keeps the payment
With Burst
- You order supplies through your main vendor
- Burst bills Medicare in your facility's name
- Your facility gets paidMedicare pays your facility directly
Diagram description. Today: your resident gets supplies from an outside supplier; the supplier bills Medicare in their name and keeps the payment. With Burst: you order the same supplies through your main vendor; Burst bills Medicare in your facility's name; Medicare pays your facility directly.
The money comes to you
You are the biller. Medicare pays your facility directly. We work as your billing team behind the scenes, sending claims in your name, using your resident charts.
Clean claims that hold up
A real person checks every claim before it goes out. If the chart doesn't back it up, we don't send it. Every claim ships with a full audit packet.
Keep your main supplier, drop the outside one
We only bill. Your regular medical supplier stays. You just stop using the outside Part B supplier and buy those same items from your regular vendor, so you keep the money and control your supply list.
You don't pay until Medicare pays you
Only paid when you get paid. If a claim is denied and the appeal fails, we eat it. You owe nothing.
Burst does the heavy lifting.
Your team keeps providing care. Burst handles the specialized Part B billing work.
Burst handles
The complete billing workflow
Find the opportunity
- Identify eligible residents
- Find qualifying supply usage
- Confirm non-Part-A dates
- Verify the billing pathway
Validate every claim
- Map HCPCS and revenue codes
- Check applicable LCD requirements
- Validate signed orders
- Match clinical documentation
- Confirm proof of delivery
- Verify refill documentation
Submit and reconcile
- Scrub claims before submission
- Submit under the facility's NPI
- Monitor claim status
- Match payments to claims
- Deliver claim-level reporting
Defend the revenue
- Correct rejected claims
- Manage denials and appeals
- Build the audit packet
- Support audit responses
- Provide audit support at no additional cost
The result
You receive the reimbursement.
Burst handles the billing. Medicare pays your facility directly.
Getting started is simple.
How fast we get going depends on how quickly you finish the short questionnaire, sign the agreements, and grant PointClickCare access. First Medicare payments usually arrive in about 30 to 45 days, but that's a typical range, not a promise.
- Step 1 · Facility
Questionnaire and agreements
- Step 2 · Facility
Read-only PointClickCare and clearinghouse access
- Step 3 · Burst
Burst reviews lookback opportunities
- Step 4 · Facility
Separate Part B supplier is discontinued
- Step 5 · Burst
Recurring eligible claims are submitted
- Step 6 · Facility
Facility receives reimbursement
Fill out a short form
Your team fills out one short form so we know your facilities, your contacts, and how you bill today.
Sign the agreements and give us access
You sign the service agreement and the HIPAA (Business Associate) agreement, then let us into your PointClickCare and clearinghouse. Our PointClickCare access is read-only.
We start looking back
Once the form, agreements, and access are done, we can usually start looking at past claims the next business day. You don't have to wait until you've dropped your old supplier.
Switch to your main supplier
To start getting monthly Medicare payments, drop the outside Part B supplier and order those supplies from your main vendor instead. You get to pick your supply list, and we handle the billing in your facility's name.
We bill and manage the claims
We find who qualifies, check the paperwork, send the claims, follow the payments, and handle any denials, appeals, or audits on the claims we sent.
Medicare pays your facility
For regular Medicare, first payments can arrive in about 30 to 45 days after we send the first claims. Medicare Advantage may take longer.
No PHI is required for the initial conversation.
Supplies we bill for you.
We bill Medicare Part B for these supplies when your residents aren't on a Part A stay and the chart backs up the claim.
A note on categories. Medicare groups some of these under a broader "prosthetic and orthotic" category. We check the exact item, the resident's status, the payer, and the paperwork before we send any claim.
What about enteral nutrition?
We don't bill regular Medicare for enteral nutrition. In some cases, we can help with enteral nutrition claims for Medicare Advantage residents when the plan allows it.
Surgical dressings
Wound-care dressings, when the chart has the doctor's order, wound notes, usage records, and proof they were delivered.
Ostomy supplies
Ostomy pouches and related items, when the resident's chart shows medical need and actual use.
Urological supplies
Catheters and related supplies, when the chart supports Medicare's coverage rules.
Tracheostomy supplies
Trach care supplies, when the chart has the order, usage, and delivery records.
Burst vs. an outside supplier
How we keep your billing clean
Every claim we send is tied to a real supply already in the resident's chart. We bill in your facility's name, using your PointClickCare records, and we include an audit packet with every claim: the doctor's order, the chart notes, and proof of delivery.
We follow the OIG's compliance guide for nursing homes. We check every supply against Medicare's local coverage rules. If Medicare ever pays too much, we report it and pay it back within 60 days, as the law requires.
HIPAA-aligned. OIG-guided. Facility-owned.
Read-only PointClickCare access. Encrypted at rest and in transit.
Every claim ships with
An audit packet
- Billed in your facility's name
- Audit packet included with every claim
- Every supply checked against Medicare coverage rules
- Read-only access to your PointClickCare
- Audit help included at no extra cost
See the full rulebook we follow
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, applied to every claim we submit
Per CMS Policy Article A55426, these four elements are required for each claim and 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.
See our seven-step compliance process
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).
How we get paid
We only get paid when you do. No upfront cost. No monthly fee. We take a small percentage of the money Medicare pays your facility.
Your exact percentage depends on how many facilities you bring on. We share the rate after a short first call, before you sign anything.
If you don't get paid, we don't get paid.
What Medicare pays your facility
Sample
Illustrative split. Actual contingency rate depends on facility count and is shared before you sign.
$0
Upfront cost
$0
Monthly fee
%
Only on collections
Client voice
“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.”
Questions we hear from every operator
- Yes. Under 42 U.S.C. § 1395x(s)(8) and CMS Medicare Benefit Policy Manual, Pub. 100-02, Ch. 15, § 120, ostomy supplies are covered as prosthetic devices under Medicare Part B. For residents without an active Part A stay, the SNF may bill the A/B MAC directly using its institutional NPI on a UB-04. Burst handles this billing on the facility's behalf under a contingency arrangement.
- Prosthetic and Orthotic Supplies (POS), such as ostomy pouches, urological catheters for permanent urinary incontinence, tracheostomy supplies, and surgical dressings, are defined under 42 U.S.C. § 1395x(s)(8) and (9) as devices replacing the function of a missing or permanently impaired body part. They are billed to the A/B MAC on a UB-04 under the facility's institutional NPI. Durable Medical Equipment (DME), such as wheelchairs, hospital beds, and CPAP machines, is defined under 42 U.S.C. § 1395x(n) and requires separate DME MAC enrollment via the National Supplier Clearinghouse. Burst bills only POS categories. Burst does not bill DME.
- No, not for the resident population Burst serves. Consolidated billing under 42 U.S.C. § 1395yy(e) and 42 C.F.R. § 411.15(p) applies only during a covered Part A stay. Long-term care residents with no active Part A benefit fall entirely outside consolidated billing. For that population, separate Part B billing of qualifying supply categories is authorized under Pub. 100-04, Ch. 7, §§ 10 and 60.
- Per CMS Policy Article A55426, four elements are required for every claim, retained for seven years from the date of service per 42 C.F.R. § 424.57(c)(12): (1) a Standard Written Order with original practitioner signature, communicated before delivery; (2) contemporaneous medical record documentation establishing medical necessity consistent with the applicable LCD; (3) proof of delivery confirming supplies were received by or on behalf of the beneficiary; and (4) for recurring supplies, documented affirmative confirmation of continued need before each refill ships.
- Every claim Burst submits is tied to a supply record already in the resident's clinical chart. Because billing follows documented clinical consumption, the workflow is designed to prevent the phantom-claim patterns auditors look for. The documentation framework is built to the OIG Compliance Program Guidance for Nursing Facilities, and facilities billing under their own NPI, tied to their own clinical record, generally hold a stronger audit position than the third-party supplier model.
- Every claim Burst submits ships with a pre-built audit packet containing the Standard Written Order, proof of delivery, medical necessity documentation, and a complete audit trail tied to your EHR. Full audit defense support is included at no additional cost, for TPE, RAC, UPIC, and MAC reviews. If an audit identifies a claim for which payment was received but was not owed, Burst reports and returns the overpayment within 60 days per 42 U.S.C. § 1320a-7k(d).
- Burst's routine SNF billing categories for traditional Medicare are surgical dressings (LCD L33831), ostomy supplies (LCD L33828), urological supplies (LCD L33803), and tracheostomy supplies (LCD L33832). Every claim must meet the applicable coverage, medical-necessity, documentation, and payer requirements. Medicare law places certain covered supplies within broader prosthetic and orthotic benefit classifications; Burst evaluates the specific item, resident status, payer, documentation, and billing pathway before submitting a claim. Enteral nutrition is not billed by Burst to traditional Medicare. In limited cases, Burst may support enteral nutrition claims for Medicare Advantage members when the applicable plan contract and billing requirements permit it.
- No. Part B supply billing is only permissible when a resident does not have an active covered Part A stay. Burst's PointClickCare integration automatically identifies Part B-eligible residents and only stages claims for qualifying dates of service. Residents in a covered Part A stay are excluded from submission.
- Your primary medical-supply vendor (for example, McKesson or Medline) can remain in place. Burst is a billing company, not a supplier, and does not sell products. Burst does recommend discontinuing any separate Part B supplier arrangement, where a supplier bills Medicare Part B under its own NPI for products delivered to your residents, and ordering those qualifying supplies through your primary vendor instead. That consolidates vendors, restores formulary control, and lets your facility bill eligible Part B supplies under its own institutional NPI and retain the reimbursement.
- Burst uses a contingency model and is paid only after your facility collects reimbursement. The exact percentage depends on the scope of the engagement, including the number of facilities or accounts involved. Burst confirms the rate after an initial sales conversation and before you make any commitment. There is no upfront implementation fee or fixed monthly billing fee.
- All of them. Burst operates in all MAC jurisdictions across all 50 states: Novitas, CGS, WPS, NGS, First Coast, Palmetto, Noridian, and Wisconsin Physicians Service.
- The CRUSH initiative targets external DMEPOS suppliers billing Medicare Part B under their own NPI with no verifiable connection to the patient's clinical record, the standard supplier arrangement most SNFs currently rely on. CMS reported $1.9 billion in improper DMEPOS payments in FY2024, with a 57.6% improper payment rate on surgical dressings billed by external suppliers. Burst submitted a formal public comment to CMS in 2026 proposing facility-side billing as the structural solution. Read the public comment at https://www.regulations.gov/comment/CMS-2026-0826-0507.
- Implementation speed depends largely on how quickly the questionnaire, agreements, PointClickCare access, and clearinghouse access are completed. Once those are in place, Burst can typically begin the lookback by the next business day. Recurring monthly reimbursement begins after the separate Part B supplier arrangement is discontinued and eligible supplies are ordered through your primary supplier. Initial traditional Medicare payments commonly arrive within approximately 30 to 45 days after the first claims are submitted; Medicare Advantage claims may take longer. These timelines are not guaranteed.
See what your facility is missing
A short call about your facilities, your PointClickCare setup, and what Part B could mean for you. No patient info needed. No cost. No commitment. We only get paid when Medicare pays you.
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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.
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Let's talk about your facilities.
A short call about your facilities, your PointClickCare setup, and what Part B could mean for you. No patient info needed. No cost. No obligation.