Beginning June 7, 2024, Indiana Medicaid launched a transformative new program: PathWays, a managed long-term service and support (MLTSS) initiative designed to streamline care for aging Hoosiers. This program partners with major health plans, Anthem, Humana, and UnitedHealthcare (United) to coordinate services and improve outcomes for Medicaid beneficiaries.
But beyond the clinical benefits, PathWays also presents a significant financial opportunity for healthcare providers if they know where to look.
Understanding the Crossover Opportunity
Medicare Bad Debt Crossover occurs when a dual-eligible patient (covered by both Medicare and Medicaid) receives services, Medicare pays its portion, but the patient’s cost-sharing (deductibles and coinsurance) is not fully reimbursed. In these cases, providers can claim the unpaid portion as Medicare Bad Debt on their Medicare cost report, provided certain criteria are met.
With the introduction of PathWays, providers may not yet realize that these managed Medicaid (MCE) plans should be treated the same as traditional Medicaid for Medicare cost reporting purposes. That means claims involving PathWays payors Anthem, Humana, and United are eligible for Medicare Bad Debt reimbursement when appropriate.
Key Questions to Ask Your Team
To ensure your organization is capturing every dollar of Medicare Bad Debt Crossover potential, start by asking these critical questions:
- Has your reimbursement team been updated on the PathWays program and its implications for Medicare Bad Debt?
- Are crossover claims from PathWays payors (Anthem, Humana, United) treated correctly in your billing system for inclusion on the Medicare cost report?
- Are PathWays remittances being retained for proper support upon Audit?
Next Steps: From Missed to Maximized
If your organization has not yet reviewed its processes after the PathWays rollout, now is the time. Our team can assist in a proactive audit of your crossover workflows, GL structure, and cost report preparation to uncover missed reimbursement opportunities and ensure you are fully compliant with Medicare regulations. Don’t let dollars slip through the cracks. With the right systems and awareness in place, your Medicare Bad Debt Crossover potential can go from missed… to maximized.
Contact Us
Blue & Co has a dedicated team of Medicare Bad Debt experts. If you have questions regarding the PathWays rollout or have not yet reviewed your processes, reach out to one of our experts today.
Stephanie Bernhardt, Senior Manager
