Skilled Nursing Billing for Indiana Facilities

What makes Indiana distinctive right now is transition risk. Before July 2024, an Indiana nursing home billed the state directly for a long-stay Medicaid resident and knew the rate. Under PathWays for Aging, that same resident is enrolled with a managed-care entity that owns the authorization, the level-of-care review, and the claim edits — and a business office built for the old fee-for-service world can suddenly find custodial days piling up unpaid while it learns three new plan portals at once. Indianapolis anchors the state's densest cluster of facilities around IU Health and Ascension St. Vincent, Fort Wayne carries a steady rehab-to-home census tied to Parkview and Lutheran, and Evansville sits in the southwest corner where Deaconess drives referrals. 247MBS builds each Indiana account around the PathWays reality — verifying plan enrollment, keeping level-of-care authorizations current across every managed-care entity, and reconciling each managed claim against the MDS that justifies it — so the move to managed LTSS does not become a cash-flow crisis.

Because Indiana just handed long-term care to managed-care entities, the largest leaks in 2024 and beyond are authorization and plan-routing failures, not coding mistakes. A PathWays plan that never re-authorized the level of care lets custodial days accrue with no payer behind them. A resident auto-assigned to a plan the facility has not yet contracted or set up leaves the claim stranded. A liability figure carried over wrong from the old state file shorts the monthly managed claim. Layer on the universal SNF traps — a late five-day MDS that misclassifies the case-mix group, a Medicare Advantage prior authorization that was never captured, and consolidated-billing confusion that either denies a bundled service or leaves an excluded one unbilled — and the transition year becomes a revenue minefield for any office working alone.

The decision to outsource skilled nursing billing in Indiana usually comes down to the PathWays transition itself. Can an in-house office stand up several new managed-LTSS workflows, keep level-of-care authorizations current across every plan, reconcile liability that just migrated out of the state system, chase Medicare Advantage approvals across the Indianapolis and Fort Wayne markets, and still tie every Part A claim to a clean, timely MDS — all in the same year the rules changed? For most operators that is more coordination than one business office can absorb. As a medical billing services company built for institutional long-term care, 247MBS runs the whole revenue cycle — eligibility and benefit verification, MDS and PDPM billing support, denial management, credentialing, and A/R recovery — under one accountable team. Our metrics are dependable: a 99% first-pass clean-claim rate, up to 40% fewer denials, 90% of worked denials recovered, and days in A/R held under 25, backed by a 98% client retention rate across two decades of professional SNF work. We are not a general billing company learning PathWays on your dime; we are a billing services company that already knows how Indiana's new managed plans behave.