Scope Overview

This engagement converts fragmented consecutive account configurations into a framework-based approach using a Consecutive Accounts Matrix.

Properly optimized consecutive account logic is both a Medicare compliance requirement and an operational imperative—reducing rework, improving reimbursement accuracy, and enabling scalable, maintainable configuration across all service areas.

 

Compliance Rationale

Medicare and other payer rules require combining or transferring charges across encounters under specific conditions, including:

• The 72-Hour Rule (Three-Day Payment Window)

• Same-Day Readmissions

• Partial Hospitalization Program (PHP) Overlap with Inpatient Admission

• Transfers and Overlapping Stays

• ESRD Consolidation

Failure to configure these scenarios correctly can result in:

• Duplicate billing or overpayment risk

• Underpayment due to missed bundling opportunities

• Increased audit exposure

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Operational Benefits

In the ideal state, optimized configuration:

• Reduces manual intervention by coders and billing teams

• Improves reimbursement predictability and cash flow

• Decreases error rates and rework

• Simplifies future maintenance and upgrades

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Framework Philosophy

Springbrook uses a matrix methodology organized by payer grouping and account base class (Inpatient, Outpatient, Emergency).

The framework emphasizes:

• Engineering first principles (minimal duplication of logic)

• Abstraction layers to simplify updates

• Clear, documented rules for when accounts are combined, flagged consecutive, or charges are transferred

Recurring accounts are explicitly considered to avoid compliance gaps in overlapping admissions.

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Pricing and Timeline
Typical Timeline: 5 months

Pricing reflects a comprehensive engagement including all service areas under a single operational owner.

 

Scope ElementBase Price

Consecutive Accounts Optimization (one operational owner, all service areas)$115,000

Each Additional Service Area (separate operational ownership)+30% per area

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Base Pricing Assumptions

This pricing assumes:

• All service areas are under one operational owner

• Client provides timely access to current configuration, test accounts, and SMEs

• Epic environments are available for configuration and testing

• No additional integrations or reporting beyond standard deliverables

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Typical Process

This project follows Springbrook’s structured implementation lifecycle:

1. Detail Scoping

   • Assess current-state configuration and payer requirements

   • Document all applicable rules, including ownership considerations for the 72-hour rule

   • Confirm scope and timeline

2. Discovery

   • Extract and analyze Epic build

   • Map compliance requirements

   • Draft the Consecutive Accounts Matrix

3. Framework Build

   • Develop payer-specific and base-class-specific combination logic

   • Configure Epic account flags, suppression logic, and charge transfer workflows

   • Peer review all configuration

4. Testing

   • Build and execute test scenarios covering Medicare and commercial rules

   • Validate correct account combination and charge transfer behavior

   • Document results and resolve defects

5. Training and Knowledge Transfer

   • Deliver live training and recorded modules

   • Provide plain-English user guides for coding and billing teams

6. Go-Live Support

   • Migrate build to production

   • Monitor claims and address any issues

7. Warranty

   • One-year warranty covering configuration degradation due to Epic upgrades or unexpected errors within original scope

 

Deliverables

• Consecutive Accounts Matrix

• Configuration Build Documentation (technical and plain-English)

• Testing Plan and Results Summary

• User Training Materials and Recorded Sessions

• Go-Live Readiness Checklist

• Warranty Terms Document

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Contact

Springbrook Consulting, LLC

Email: info@springbrookconsulting.com

Phone: 260-715-9342