Service line 05 - Medicare Part B inpatient

Medicare Part B Inpatient Billing

Five scenarios. Deterministic claim fields. HB.

When Medicare denies an inpatient stay for medical necessity, or benefits exhaust mid-stay, the organization is entitled to bill Part B - if the claim carries the right type of bill, occurrence codes, and remarks, in the right sequence, for the right scenario. Most shops handle this by hand and miss cases. This engagement configures Epic HB to identify and automate all five scenarios, with deterministic field population, billing-indicator governance, and secondary payer handling.

Outpatient-only and Medicare Advantage are excluded.

What we deliver

01AB rebill

02Full exhaust

03Partial exhaust

04Part B only inpatient

05Straight Part B

Logic design for all five scenarios
Claim definition, claim code automation, and claim form overrides
Workqueue and Batch WQ Rule build
Billing-indicator governance
Secondary payer methodology
Documentation across all service areas under a single decision maker

How the engagement runs

Scoping confirms which scenarios you handle today and who owns the proactive path.

Discovery confirms which of the five scenarios the organization handles now, utilization management's role in the proactive rebill path, and the secondary payer mix. Scope is fixed at the end of Discovery.

Discovery

4 wks

Build

8 wks

Test

4 wks

Go-live support

6 wks

What we measure

Technical outcomes, at baseline and 90 days after go-live.

Auto-generated Part B claimsShare of qualifying denials and exhausts that generate the correct Part B claim automatically.

Field accuracyClaim field accuracy on first submission.

Days to Part B claimFrom denial or exhaust to the Part B claim out the door.

Pricing

ServiceFixed fee

Medicare Part B Inpatient Billing - HB

$175,000

Covers all service areas under one decision maker. Each additional operational owner is +30% per the standard modifiers. Bundle with any other service: 15% off the second, 20% off the third and beyond.

Modifiers

Two or more services in one contract: 15% off the second, 20% off the third and each additional, applied to the lower-priced services
Each additional service area, same operational owner: +15%
Each additional operational owner: +30%
Payers beyond five, where payer count drives build: flat per-payer add

Assumptions

All service areas under one decision maker per fee
One client analyst participates 1-2 hours per week for knowledge transfer; client resources do not perform build or testing
Production and a recent-clone environment available for the duration
Current configuration, test accounts, representative files, and SME access provided within 10 business days of start
Any clearing-vendor engagement required by scope is complete before start
Utilization management participates in scoping the proactive rebill path

Warranty

One-year warranty on all in-scope deliverables, covering configuration degradation from Epic upgrades or defects within the original scope. Full build documentation, plain-English user guides, and recorded training delivered at go-live.

Book a scoping call

Scoping confirms your current scenario coverage and secondary payer mix.