Overview

Medicare Part B Inpatient Billing ensures hospitals can compliantly bill Medicare for appropriate services when inpatient claims are denied or benefits are exhausted. This work helps secure correct reimbursement, reduce patient liability, and support clean secondary claim submission to Medicaid and other payers.

Springbrook Consulting provides a complete configuration, testing, and training engagement to deliver this solution efficiently and reliably.

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Base Pricing and Timeline

ItemDetails

Base Price$100,000

Typical Timeline5 months from project kickoff

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Pricing Assumptions

• Pricing includes configuration of one complete set of Hospital Billing (HB) CDFs to support Medicare Part B Inpatient Billing.

• This single set of CDFs may be shared across multiple legal entities or Service Areas, provided they use a common configuration.

• All four billing scenarios are included:

  • AB Rebill

  • Part B Only Inpatient Billing

  • Full Exhaust

  • Partial Exhaust

• Scope includes both secondary claim configurations:

  • Claims split exactly as billed to Medicare

  • Recombined claims showing all charges

• Additional sets of CDFs with unique configuration needs may require separate scoping.

 

Scope of Services

This project delivers a complete end-to-end Medicare Part B Inpatient Billing build, including:

• Discovery and Planning

  • Review of current billing workflows and denial handling processes

  • Validation of payer-specific requirements for secondary claims

  • Confirmation of regulatory compliance needs

• Technical Configuration

  • Automated claim creation logic for each billing scenario

  • Revenue code filtering to enforce Medicare coverage limitations

  • Denial recognition workflows triggering appropriate resubmission

  • Dynamic population of required claim fields, including:

    • Condition Code W2 (AB Rebill)

    • Occurrence Code 22 (Exhaust scenarios)

  • Rules to prevent conflicting workflows

• Testing and Validation

  • End-to-end test cases covering all scenarios

  • Validation of timely filing logic

  • Verification of clean remittances and secondary claim processing

• Training and Documentation

  • Standard operating procedures for billing and follow-up staff

  • Job aids for identifying scenarios and processing remittances

  • Reference materials describing all configurations

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Pricing Table

Service ComponentIncluded

Configuration of All Four ScenariosIncluded

Secondary Claim Handling (Split and Recombined)Included

Single Set of HB CDFs (Shared Across Legal Entities if Applicable)Included

End-to-End TestingIncluded

Staff Training and DocumentationIncluded

Base Price$100,000

Typical Timeline5 months

 

Technical Details

Your configuration will include:

• Claim Types

  • Type of Bill 12X or 121 for AB Rebill and Exhaust

  • Type of Bill 13X for pre-admission services in AB Rebill

  • Type of Bill 111 for initial inpatient claim submission

• Automations

  • Denial detection and classification (AB Rebill vs. Exhaust)

  • Dynamic selection of claim type and field population

  • Automated claim splitting or recombination for secondary billing

• Revenue Code Controls

  • Ancillary services restricted per Medicare Benefit Policy Manual §10.2

  • Edits to prevent submission of unallowable services

• Field Population

  • Occurrence Code 22 for exhaust scenarios

  • Condition Code W2 and NTE Denial Reference for AB Rebill

  • Standard admission, discharge, and patient status codes

• Sequencing Logic

  • Primary claim submission to Medicare

  • Secondary claim preparation with attached Medicare adjudication details

 

Contact

Springbrook Consulting, LLC

Email: info@springbrookconsulting.com

Phone: 260-715-9342