Home Health & Hospice Week

'HIGLAS' system in place at one RHHI, on deck for the rest. Get ready to take on more billing confusion, thanks to a new Medicare accounting system known as HIGLAS.

Regional home health intermediary Palmetto GBA implemented the Healthcare Integrated General Ledger Accounting System on May 4, the Department of Health and Human Services says in a May 24 release about the change. HIGLAS is part of a wider accounting system change for all the departments under HHS.

"HIGLAS centralizes one duplicative processing for collecting and reporting financial data to allow for the better detection and resolution of errors in a timelier manner," HHS says. "We have taken aggressive steps to ensure that we are paying Medicare claims appropriately," Centers for Medicare & Medicaid Services Administrator Mark McClellan says in the release.

HIGLAS doesn't replace the Fiscal Intermedi-ary Shared System (FISS) for claims processing, Palmetto stresses in an April 22 letter to providers. Rather, "this transition is only for the financial accounting system," the RHHI emphasizes.

The new system is pushing back RAP payments, saddling some unlucky providers with debts that aren't theirs and generally causing confusion. HIGLAS also is instituting minor procedural changes (see related story, later in this issue). The other three RHHIs are scheduled to implement HIGLAS within four years, a CMS spokesperson says.

But the RHHIs don't know yet exactly when that implementation will occur. "We have received no dates on HIGLAS," a Cahaba GBA official tells Eli. You'll Have to Wait Extra Day for RAPs The most widespread effect of the change will be a delay to request for anticipated payment (RAP) reimbursement. Palmetto currently takes seven days to process RAPs, and under HIGLAS it will add a day to that schedule, the intermediary explains in a May 23 posting to its Web site.

Old way: Status/location PB9996 used to mean "on the payment floor" and applied only to claims waiting to meet the payment time limit, Palmetto explains. Because RAPs aren't subject to a payment floor, they never used to be in PB9996.

New way: Now PB9996 indicates that the claim has "adjudicated" through FISS claims processing and is awaiting payment, and so the code can apply to both RAPs and final claims. "When a RAP is loaded to HIGLAS, it will be paid immediately because there are no payment floor requirements on RAPs," Palmetto instructs. But loading the RAP into HIGLAS adds the extra day, a Palmetto official explains to Eli.

Palmetto is already the slowest of the RHHIs at paying RAPs, says Abilene, TX-based reimbursement consultant Bobby Dusek. While other intermediaries take three to five days on average to pay RAPs, Pal-metto takes seven.

Palmetto used to pay RAPs faster when the prospective payment system began, points out Lynn Olson with billing [...]