Home Health & Hospice Week

Expect RAP delays, mystery withholdings.

If you're experiencing a wave of billing and accounting confusion following National Government Services' switch to the HIGLAS accounting system Aug. 9, you're not alone.

HIGLAS changes the financial accounting system that NGS uses, but it has ramifications for provider payments. When Palmetto GBA switched to HIGLAS in 2005, agencies experienced a range of problematic changes from claims delays to withholds for companies they'd never heard of (see Eli's HCW, Vol. XIV, No. 20).

NGS, formerly United Government Services and Associated Hospital Service of Maine, lists the same changes in a letter to providers posted to its Web site in late July. Some of those changes include:

• RAP delays. Processing certain claims will now take an extra day because they have to go through location PB9996 for the payment floor, NGS describes in the letter. Even though RAPs aren't subject to the payment floor, they still have to go through that location. "The one-day delay ... is not an error," NGS tells providers. "This has been identified as a permanent change resulting from the HIGLAS transition."

• Overpayment letter delivery. NGS will now deliver overpayment letters to the "master physical address" of the provider instead of the Audit and Reimbursement contact ID'd by the provider previously.  

• Affiliated provider recoupments. NGS now will make recoupments from any provider sharing your Tax ID number, so you'd better make sure you have the correct one on file with Medicare.

And good luck identifying the source of those affiliated recoupments. "On the [electronic remittance advice], a code of 'OA' is used for Part A Affiliated Withholdings, and a code of 'OB' is used for Part B Affiliated Withholdings," NGS details. "However, the paper RA does not contain any information to distinguish affiliated withholdings from other withholdings."

Cahaba GBA is the only regional home health intermediary not yet on the HIGLAS system. CMS pledged in 2005 to have all Medicare contractors on the system by 2009.

Note: NGS' letter is at www.ugsmedicare.com/documents/HIGLAS20Notification.pdf.