Home Health & Hospice Week

Expect changes to check reissuances, third-party withholdings too. If Palmetto GBA is late in paying your prospective payment system final claim, the intermediary won't compensate you as much as it used to.

The new HIGLAS accounting system (see story, p. 154) is bringing changes to claims processing timeliness (CPT) rules. "Final claims will now have CPT interest calculated on the net final claim amount, rather than on the gross final claim amount," regional home health intermediary Palmetto explains in an April 22 letter to providers.

In other words, Medicare will give you interest only on the amount of your total PPS episode payment minus the request for anticipated payment (RAP) amount, explains Abilene, TX-based reimbursement consultant Bobby Dusek.

Formerly, Palmetto gave interest on the whole PPS episode amount, even though an agency received either 50 or 60 percent of that amount in the RAP, Dusek says. That's because under PPS, RAPs don't count as real claims to avoid the payment floor - thus the RAP amount technically is recouped and then paid out again simultaneously on the final claim.

Switching to paying interest on only the remainder of the episode payment after the RAP is only fair, Dusek judges. The other RHHIs will adopt the HIGLAS changes when they adopt the system within the next four years.

Other HIGLAS changes include:
  Check reissuances. Instead of automatically reissuing a check when a payment is voided (for example, when a check gets mutilated in the mail), Palmetto will run the reissued check through HIGLAS to again check for any withholdings that may apply against the reimbursement. Confusion may arise as Palmetto may add claim payments to the check as well, and the new check won't come with a copy of the original RA as it used to.
  Third-party withholdings. Under HIGLAS, providers now receive notice via an RA if Palmetto withholds reimbursement to pay a third party, such as the IRS. Formerly, Palmetto furnished no notification.