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Are you losing thousands per month on Medicare B supplies?

Long-term care leaders have grown tired of being treated like second class providers. While hospitals charge $37 for a Tylenol, SNFs can’t get paid for supplies that save lives. All because CMS created a loophole that says SNFs are licensed care providers AND homes for their patients.

There’s something you can do about it! But first...

9/10 SNFs don’t get paid for their Med B supplies.

They‘ve been told one of three myths:

Myth One

Your supplier bills for you: “You get your Med B supplies for free”

This myth is the only one with a grain of truth.

If you have a supplier like Calmed, AMT, Curitec, Lincare, Restorix, etc, then they are billing for and sending you supplies.

They’ll tell you “You get your supplies for free.”

And while you don’t see an expense on your P&L or pay an invoice for the supplies they send, you’re missing out on the profits they generate.

Here’s how they can send you supplies at no charge:

You order supplies. In this case, say you order a Bordered Foam Dressing 6x6.
Your supplier prequalifies, checks eligibility, and coverage requirements.
If covered, the supply is delivered to your doorstep.
If not covered, you‘re notified and required to order that supply from your primary supplier, like McKesson or Medline.
If covered, the supplier bills for the supply on the backend, keeping the difference between the cost of the supply, admin work to place the order, and delivery costs. They keep your profits!

The Problem with using a supplier to bill for you

Delayed Delivery

They must prequalify the supply to ensure they’ll be paid for it. This can lead to delivery delays. It’s not hard to imagine a scenario where they’re short staffed or it’s a holiday so they can’t prequalify the supply quickly. Now you’re left waiting, while your patient‘s wound festers. Can you say harm tag?

Cheap Products

They’re incentivized to send you their cheapest supply to maximize their profit margins. Why send you the Smith & Nephew for $10 per pad when the $2 Curitec provides so much more profit for them? provides so much more profit for them? Shouldn‘t you get to pick your supplies?

Stolen Profits

They’re keeping profits that belong to you. If they send you a $2 foam dressing and bill Medicare $10, they keep your $8 profit. Why should they profit off of the clinical care YOU provide? How does that make sense? Do you think hospitals would go for this?

Myth one (almost) busted. While you aren’t paying for these supplies, your supplier is keeping the profits you deserve.

If you’re saying to yourself “It’s convenient” then perhaps you should read on.

I use them because it’s convenient.

Why is it convenient? Because they do all of the work!

Okay, fine. But what work have they created for you?

Here’s a fact:
You now have at least two suppliers when you only need one.

The Big Fish, like McKesson, and one or more Little Fish, like Curitec. (Multiple Little Fish if they only provide certain supplies. Some only provide wound. Others, only enteral.)

Why do you NEED to or more suppliers?

Multiple suppliers means:

Separate training for clinicians and central supply
More opportunities for miscommunication
Multiple invoices and/or patient data
Different account managers
Different formularies
Unpredictable Costs
Multiple logins

Which is more convenient?

Ordering from one vendor, with one point of contact, one formulary, one staff training, and predictable costs or multiple vendors with 2x the demand on you and your team?

A HUGE caveat!

They only bill for what they send. I can all but guarantee they don’t send all of your Med B-covered supplies.

Everything sent by an alternate vendor or by a Big Fish, is just sitting there waiting to be billed.

This is typically 30% of your “Cost Avoidance”. The amount your supplier saves you each month. More on this later!

Here’s the second grain of truth and part of Myth 3 In most cases, it is too expensive to process these claims internally. Without the software we’re building it takes an average of 7 hours to process one month’s data, not including tracking denials and prior auths.

If you outsource the process however, you can consolidate suppliers and still turn a profit.

We’ll get to profitability. What about the cost of doing business?

Myth Two

It’s a necessary part of doing business - “You write them off”

This stems from a belief that running a nursing home has certain built in costs and one of them is paying for Medicare B-covered supplies.

This only makes sense in two scenarios:

Don’t feel bad if you haven’t run the numbers. The status quo is strong with this one.

Most people believe that paying for Med B-covered supplies is like paying for briefs and alcohol wipes - a part of doing business. It isn’t!

And this is why Myth One is so powerful. Because you believe you get a small percentage of your “It’s the cost of doing business” supplies for free.

While partially true, it’s not the whole truth!

Medicare B covers a number of supplies and SNFs can make thousands per month on them.

All of these supplies are covered under Medicare B

and the profits are healthy. The issue is that getting paid for them is resource intensive. Business Office Managers (BOM) must spend hours and hours pouring over Medication and Treatment records to find individual supplies.

Supplies like:

Vaccinations, Influenza and Pneumonia
Enteral supplies for Advantage payers
Urological and Ostomy supplies
Orthotic braces or splints
Tracheostomy supplies
CLIA-waived lab tests
Wound care supplies

It’s not the cost of doing business and I’ll prove it in Myth Three

Myth Three

It’s not worth your effort - “The ROI is too small”

This myth is based on several misconceptions. They sound something like this:

“It costs more to bill for them than they reimburse.” “Med B-covered supplies aren’t worth my time.” “They’re not worth very much money.”

Wrong, wrong, wrong!

Let’s start with the first & second misconceptions; “It costs more to bill for them than they reimburse” and “Med B-covered supplies aren’t worth my time”.

We’ve already addressed the time investment above. Done manually, it takes about 7 hours a month.

That’s one full day for your BOM or Medical Records. What do they make per hour?

Let’s go high and say it costs you $40 per hour. That means one day costs you $280 to process claims.

Put another way, it costs you $280 per month to process your own Med B claims.

So the only way this makes sense is if your profits are more than your time invested. There’s an simple way to figure this out.

Calculate how much you can make.

Here’s an easy way to approximate your ROI?

Contact your Med B supplier. Ask them to send you three months worth of supplies and how much they cost?

(You may need to contact one for wound, one for trache, and one for enteral, etc.)

You’ll get a hodgepodge of excel sheets but they’ll all have one thing in common: They’ll tell you how much you “saved” or in the case below, your “Estimated Cost Avoidance”

Let’s look at a specific month to simplify things

This facility saved $2,040 dollars by using their supplier.

In other words, without your supplier billing for these supplies you would have spent $2,040 more on supplies in October.

Now that you know the cost. Calculate the profit.

How much does your supplier make on the supplies they bill for? Let’s take a closer look on the next page.

Typical margins on some commonly ordered supplies.

As you can see, the margins are healthy. While these are based on national averages, they’re the same numbers we use to help clients guess their potential profits.

A foam dressing that goes for $5, reimburses at $23.

Since we don’t have your actual costs, we can approximate using the table below and the costs above.

Assume you absorb the cost for supplies:

$2,040

Now take the average margins from the table to the right and do the math.

Here‘s what you get:

Total: $556.08

Minus your cost of $280 and your profit is $276.08.

You paid $280 to make $556. That’s an investment!

How about a real world example using Amazon?

But guy, these ,cost $22 and Medicare, according to your graph above, reimburses at $23. What gives?

Look closer

This box contains 5 pads. That means that each pad is worth $4.98.

And Medicare reimburses $23 per pad!

That’s $18 profit per pad!

Tell me... what are your best margins, on your best day?

They’re not 20% plus. Are they?

Are they?

We’ve just proven that it does not cost more to bill for supplies AND it’s worth your time.

Misconception One: “It costs more to bill for them than they reimburse”

BUSTED

Misconception Two: “Med B-covered supplies aren’t worth my time”

BUSTED

What’s left? “They’re not worth very much money!”

Sorry to say it but this is the wrong approach. McDonalds cheeseburger’s aren’t worth very much money but the margins are killer.

What’s more important, the price of the cheeseburger or the margin on that cheeseburger?

You guessed it again. The margin!

You’ve already seen the percent profits are about as good as it gets in long-term care. When your own profits hover around 5% (7-9% on your best months), how can you justify overlooking 20%?

Great Eric... why would we use you to do this?

You just proved WE should do it ourselves

You got me. The truth is that I encourage all clients and prospects to do this. Reality paints a much different picture however.

This means that you’ll have an almost impossible bridge to cross in order to implement this yourself.

Don’t believe me?

I have a little challenge for you?

Find your best biller and ask them the following questions:

What are the minimum criteria for submitting claims on a wound in a SNF?
Which stages and amount of discharge are required to cover a wound?
What documentation is required for said wound?
What specific supplies are covered under Medicare B?
Describe the process you would use to bill for a patients supplies? How would you incorporate the Medication and Treatments records, Census, Common Working File, and Facesheets?
Which Advantage plans do and do not cover the supplies?

If your biller can answer these, sit down with them immediately and start building a workflow.

If however, they are like the 99/100 billers we encounter, they will know a little about Med B but not so much on how to bill Med B in SNFs.

The qualifications are numerous and no one is taught this stuff in school.

If you still doubt me, remember how hard the government has worked to make your lives hell. You’re this amalgamation of hospitals and home health. Neither black or white. And in this case, there’s no where you can go to find a flowchart that says “Do this. Now do this. Now this. Then that.”

If you elect to go it alone. You’re on your own. You will be developing your model from scratch.

From the ground up.

You can (and should) do this.

If however, you’ve got corporate breathing down your neck, staff fleeing in droves, state throwing tags, and a family you’d like to see every now and then,

You should consider outsourcing your Med B billing.

5 reasons you should consider Burst Medical Billing for your Med B supplies.

There’s no upfront cost

To start, we run a review of your supplies to see how much you stand to make. Once finished, we’ll share that information and let you decide if it makes sense to work with us.

You can choose to use us for a one-time submission for a larger cut of the receivables or sign an annual contract for a discounted rate.

Either way, once greenlit, we’ll get to work processing claims that get paid directly to you from the payer.

If you make nothing we make nothing.

(And if you’re squinting because you want to know HOW MUCH we charge, well that’s a conversation I like to have in person, but it will be based on this formulary:

To help contain costs...

I recommend keeping your Little Fish supplier in the beginning.

First, because it’s less disruptive for your team and

Second, because we want to make sure your supplies are profitable before making the switch.

This means, we’ll start with all of the supplies they don’t provide (believe me, there are plenty), then we’ll make a recommendation after 3-6 months, using data, as to whether or not its profitable to consolidate suppliers.

Remember, if you make nothing, you pay nothing

5 reasons you should consider Burst Medical Billing for your Med B supplies.

Pay ONLY after you’ve been paid

We bill as though we were you. We work with your clearinghouse and under your supervision.

This means that Medicare pays you for the work we do.

They deposit your remittances directly to your account so you never have to question the amount your receiving or speculate on our pricing.

After guaranteeing the funds have hit your account, we send you an invoice with a customized analysis for your review.

It includes a Facility Snapshot

And Recommended Formulary

Page One

Global Facility Breakdown

Page Two

Facility Snapshot

Page Three

Common Med B Supplies

Page Four

Hypothetical Customized Formulary

Global Facility Breakdown

December 2023

Top Producer: IJK Facility $9,856 last month; Avg/m $7,864; YTD $94,369

Bottom Producer: RST Facility $1,221 last month; Avg/m $1,569, YTD $18,828

Cost Containment Opportunities:

Decrease costs at DEF, LMN, RST, & UVW. (Small % margin.)

ABC Nursing Facility

December 2023

Congratulations.

Opportunities:

YTD Cost vs. Profit

Common Medicare B-Covered Supplies

December 2023

What’s Billable?

Vaccinations, Influenza and Pneumonia
Enteral supplies for Advantage payers
Urological and Ostomy supplies
Orthotic braces or splints
Tracheostomy supplies
CLIA-waived lab tests
Wound care supplies

Recommended Formulary

December 2023

Disclaimer: The information provided in this table is for reference and demonstration purposes only. The product names, manufacturer numbers, costs, Medicare allowable amounts, and variances are purely hypothetical and should not be considered accurate or reflective of real-world data. This table is intended to illustrate how such a formulary might be structured and should not be used for actual medical supply procurement or reimbursement calculations. Users are advised to consult directly with suppliers, Medicare, or relevant healthcare authorities like Burst Medical Billing for precise and current pricing and reimbursement information.

Disclaimer: Burst Medical Billing offers reviews of medical supply costs and reimbursements but does not legally advise on which supplies to choose. We provide options for healthcare providers to make informed decisions. Final selection of supplies is the responsibility of healthcare providers, considering clinical needs and regulatory compliance.

For an accurate review of medical supply costs and potential reimbursements, contact Burst Medical Billing at 720-660-5395 or support@burstbilling.com. Give us 72 hours and we’ll tell you how much your supplies are worth.

Burst Medical Billing helps SNFs get paid for their Medicare B-covered supplies and to understand the complexities of Medicare B billing

Are you losing thousands per month on Medicare B supplies?

Long-term care leaders have grown tired of being treated like second class providers. While hospitals charge $37 for a Tylenol, SNFs can’t get paid for supplies that save lives. All because CMS created a loophole that says SNFs are licensed care providers AND homes for their patients.

There’s something you can do about it! But first...

9/10 SNFs don’t get paid for their Med B supplies.

They‘ve been told one of three myths:

Your supplier bills for you: “You get your Med B supplies for free”

It’s a necessary part of doing business: “You write them off”

It’s not worth your effort: “The ROI is too small”

Myth One

Your supplier bills for you: “You get your Med B supplies for free”

This myth is the only one with a grain of truth.

If you have a supplier like Calmed, AMT, Curitec, Lincare, Restorix, etc, then they are billing for and sending you supplies.

They’ll tell you “You get your supplies for free.”

And while you don’t see an expense on your P&L or pay an invoice for the supplies they send, you’re missing out on the profits they generate.

Here’s how they can send you supplies at no charge:

The Problem with using a supplier to bill for you

Delayed Delivery

Cheap Products

Stolen Profits

Myth one (almost) busted. While you aren’t paying for these supplies, your supplier is keeping the profits you deserve.

If you’re saying to yourself “It’s convenient” then perhaps you should read on.

I use them because it’s convenient.

Why is it convenient? Because they do all of the work!

Okay, fine. But what work have they created for you?

Here’s a fact: You now have at least two suppliers when you only need one.

The Big Fish, like McKesson, and one or more Little Fish, like Curitec. (Multiple Little Fish if they only provide certain supplies. Some only provide wound. Others, only enteral.)

Why do you NEED to or more suppliers?

Multiple suppliers means:

Which is more convenient?

Ordering from one vendor, with one point of contact, one formulary, one staff training, and predictable costs or multiple vendors with 2x the demand on you and your team?

A HUGE caveat!

They only bill for what they send. I can all but guarantee they don’t send all of your Med B-covered supplies.

Everything sent by an alternate vendor or by a Big Fish, is just sitting there waiting to be billed.

This is typically 30% of your “Cost Avoidance”. The amount your supplier saves you each month. More on this later!

Here’s the second grain of truth and part of Myth 3 In most cases, it is too expensive to process these claims internally. Without the software we’re building it takes an average of 7 hours to process one month’s data, not including tracking denials and prior auths.

If you outsource the process however, you can consolidate suppliers and still turn a profit.

We’ll get to profitability. What about the cost of doing business?

Myth Two

It’s a necessary part of doing business - “You write them off”

This stems from a belief that running a nursing home has certain built in costs and one of them is paying for Medicare B-covered supplies.

This only makes sense in two scenarios:

Don’t feel bad if you haven’t run the numbers. The status quo is strong with this one.

Most people believe that paying for Med B-covered supplies is like paying for briefs and alcohol wipes - a part of doing business. It isn’t!

And this is why Myth One is so powerful. Because you believe you get a small percentage of your “It’s the cost of doing business” supplies for free.

While partially true, it’s not the whole truth!

Medicare B covers a number of supplies and SNFs can make thousands per month on them.

All of these supplies are covered under Medicare B

and the profits are healthy. The issue is that getting paid for them is resource intensive. Business Office Managers (BOM) must spend hours and hours pouring over Medication and Treatment records to find individual supplies.

Supplies like:

It’s not the cost of doing business and I’ll prove it in Myth Three

Myth Three

It’s not worth your effort - “The ROI is too small”

This myth is based on several misconceptions. They sound something like this:

“It costs more to bill for them than they reimburse.” “Med B-covered supplies aren’t worth my time.” “They’re not worth very much money.”

Wrong, wrong, wrong!

Let’s start with the first & second misconceptions; “It costs more to bill for them than they reimburse” and “Med B-covered supplies aren’t worth my time”.

We’ve already addressed the time investment above. Done manually, it takes about 7 hours a month.

That’s one full day for your BOM or Medical Records. What do they make per hour?

Let’s go high and say it costs you $40 per hour. That means one day costs you $280 to process claims.

Put another way, it costs you $280 per month to process your own Med B claims.

So the only way this makes sense is if your profits are more than your time invested. There’s an simple way to figure this out.

Calculate how much you can make.

Here’s an easy way to approximate your ROI?

Contact your Med B supplier. Ask them to send you three months worth of supplies and how much they cost?

(You may need to contact one for wound, one for trache, and one for enteral, etc.)

You’ll get a hodgepodge of excel sheets but they’ll all have one thing in common: They’ll tell you how much you “saved” or in the case below, your “Estimated Cost Avoidance”

Let’s look at a specific month to simplify things

This facility saved $2,040 dollars by using their supplier.

In other words, without your supplier billing for these supplies you would have spent $2,040 more on supplies in October.

Now that you know the cost. Calculate the profit.

How much does your supplier make on the supplies they bill for? Let’s take a closer look on the next page.

Typical margins on some commonly ordered supplies.

As you can see, the margins are healthy. While these are based on national averages, they’re the same numbers we use to help clients guess their potential profits.

A foam dressing that goes for $5, reimburses at $23.

Since we don’t have your actual costs, we can approximate using the table below and the costs above.

Assume you absorb the cost for supplies:

$2,040

Now take the average margins from the table to the right and do the math.

Here‘s what you get:

Total: $556.08

Here’s a fact:
You now have at least two suppliers when you only need one.