SNF Part B billing: questions and answers

CareComply is a done-for-you Medicare Part B billing partner for skilled nursing facilities. We bill Part B supplies (wound care, ostomy, urological, tracheostomy, and splints and orthotics) and respiratory therapy under the facility’s own NPI, monitor documentation compliance every day, and find revenue the facility is missing.

Whoever submits the claim under their NPI. Many SNFs use a supply vendor that bills Medicare under the vendor’s NPI and keeps the reimbursement. With CareComply, claims are billed under the facility’s NPI, so Medicare pays the facility.

The supplies aren’t free; your residents’ Part B benefit is paying for them. Medicare reimburses more than the supply costs, and the vendor keeps that margin in exchange for not invoicing you. In-house, you pay the supplier’s invoice and keep the margin.

Yes. A SNF can bill Medicare Part B for surgical dressings, ostomy, urological, and tracheostomy supplies, and splints and orthotics under its own NPI for residents who are not in a covered Part A stay. CareComply does the billing and compliance work, so bringing it in-house doesn’t add staff.

You stop the Part B billing arrangement with the vendor and keep ordering supplies from your regular supplier for all residents. CareComply bills the Part B–eligible usage under your NPI.

Residents who are not in a covered Part A stay, have active Medicare Part B, an eligible primary payer, and no active Medicare Advantage plan (unless the facility has an arrangement with that plan). CareComply checks this for every resident every day.

We monitor documentation compliance every day and flag gaps before month-end, instead of only reviewing claims afterward. We proactively find missed revenue, such as better-reimbursing products and residents nobody is billing for. And we also run full Part B respiratory therapy programs.

CareComply is paid on contingency, as a percentage of revenue we bill and collect for you. There is no setup fee, and the first step is a free sample scan of your facility’s real data.

Yes. Medicare generally allows claims to be filed up to 12 months after the date of service, so we run a 12-month lookback to bill eligible services you already provided. Each month you wait, another month of that revenue passes the filing limit.

No. CareComply works from the data already in PointClickCare and your eMAR. Your team keeps documenting the way it does today and fixes the specific gaps we flag.

Yes. The Social Security Act lists surgical dressings, prosthetic devices, and orthotics as Part B benefits, and the CMS Claims Processing Manual (Pub. 100-04, Chapter 7) describes how SNFs bill Part B for residents who are not in a covered Part A stay.

Surgical dressings for wound care (LCD L33831), ostomy supplies (LCD L33828), urological supplies (LCD L33803), tracheostomy care supplies (LCD L33832), and splints and orthotics. Durable medical equipment such as wheelchairs and hospital beds is a separate benefit and is not included.

A practitioner order, medical record documentation that supports medical necessity under the applicable LCD, records showing the supply was used for the resident, and quantities within the policy’s limits.

Yes. For residents not in a covered Part A stay who have active Part B, a SNF can bill medically necessary surgical dressings under its own NPI, following LCD L33831 and the standard documentation requirements.

Yes, for residents not in a covered Part A stay. Ostomy supplies fall under the prosthetic device benefit and can be billed by the SNF under its own NPI.

Yes, when the resident’s urinary condition is permanent and documented, the resident has active Part B, and they are not in a covered Part A stay.

Yes. Tracheostomy care supplies are a prosthetic device benefit, billable by the SNF for residents not in a covered Part A stay.

Yes, for residents not in a covered Part A stay, when the device is ordered and medically necessary. Durable medical equipment like wheelchairs is a different benefit and is not included.

Your facility’s clinical team delivers the therapy. CareComply is the eligibility, compliance, and billing layer: we tell your team which residents qualify, check every RT order’s documentation daily, and bill the eligible days under your NPI.

It starts with a free sample scan of your current residents, which shows how many likely qualify. From there, we connect to PointClickCare and your team starts receiving daily eligibility and compliance reports; we’ll give you a plan in the first conversation.

It depends on your Medicare Administrative Contractor. Noridian, Novitas, and Palmetto each publish the respiratory diagnoses they accept. Common examples include COPD, chronic respiratory failure, and pneumonia-related conditions. CareComply applies your contractor’s list automatically.

Generally not billed as straight Part B. A resident on an active Medicare Advantage plan is ineligible unless the facility has an arrangement with that plan. When a resident disenrolls from Medicare Advantage, our report flags them as newly eligible.

Yes. For residents who are not in a covered Part A stay and meet Part B eligibility and diagnosis requirements, the SNF can bill Part B respiratory therapy services under its own NPI.

Yes. Pulse oximetry (94760, 94761) needs a qualifying pulse-ox diagnosis on the resident’s record. CareComply checks this daily and flags orders that would not be billable.

An order specifying the therapy, CPT code, and frequency; a qualifying diagnosis; physician documentation of medical necessity; and administration records showing the therapy was delivered.

A pre-billing review finds problems after the month is over, when many of them can no longer be fixed. CareComply checks every day, so your team fixes gaps while the therapy is still being delivered.

CareComply checks every supply and RT order against Medicare documentation requirements every day and emails your team a report of what is missing, such as a dressing size, a wound location, a qualifying diagnosis, or a physician note. Your team fixes it while the claim is still billable.

Every claim we bill is tied to the order, administration record, and documentation in your chart, and our daily reports show the compliance checks that were run. That makes it straightforward to respond to a documentation request.

We review a sample of your facility’s real data and show you the Part B revenue you’re currently missing and the compliance gaps you have today. There is no cost and no commitment.

CareComply integrates with PointClickCare for census, payer, diagnosis, and eMAR data, and checks Medicare eligibility directly with CMS data.