The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

• CMS Internet-Only Manual (IOM), Publication 100-08, Chapter 6; Resident Assessment Instrument(RAI) User’s Manual for the Minimum Data Set (MDS);http://www.cms.gov/manuals/downloads/pim83c08.pdf• National Government Services LCD #L26861 for SNFs (Including Swing Beds),http://apps.ngsmedicare.com/sia/ARTICLE_A46184.htmNational Government Services Articles for Part B ProvidersNational Government Services J13 Part B to Transition to HealthcareIntegrated General Ledger Accounting System (HIGLAS)Effective February 11, 2011, National Government Services will be transitioning our Jurisdiction 13 (J13)(Connecticut and New York) Part B financial accounting system from the Multi-Carrier System (MCS) tothe Healthcare Integrated General Ledger Accounting System (HIGLAS). This transition involves onlyour financial accounting system. We will continue to use MCS for all of our claims processingactivities.Implementation of HIGLAS will enable the Centers for Medicare & Medicaid Services (CMS) to trackMedicare payments and to accurately pay claims for over 40 million Medicare beneficiaries. Thetransition will also provide CMS with enhanced oversight of contractors’ accounting systems, as well asaccess to more accurate, timely, and consistent data for decision-making and for performanceevaluations.National Government Services HIGLAS TransitionThe purpose of this letter is to explain the impact that the National Government Services HIGLAS transition willhave on your organization’s Medicare payments. It also provides a detailed transition timeline, revised paymentschedules, and other important information regarding upcoming changes. In an attempt to make the transition assmooth as possible, we are providing you with this information to ensure minimal disruption in your Medicarepayments.We ask that you please take time to carefully read this information and that you share it with theappropriate staff in your organization.Introduction to HIGLASA HIGLAS training module will be available soon on the National Government Services Web site.Updated information regarding our HIGLAS implementation will be provided via the NationalGovernment Services HIGLAS Web site at www.NGSMedicare.com or by accessing NationalGovernment Services Web site at www.NGSMedicare.com and selecting “HIGLAS Transition for Part B –Connecticut and New York Providers” under Hot Topics. This same information will be issued in our e-mail updates and published in the Medicare Monthly Review.Temporary Waiver of the Claims Processing Payment FloorCMS has approved National Government Services’ waiver request to reduce the payment floor for both paper andEDI claims. Beginning February 9, 2011, the payment floor will be reduced to zero for both EDI and paper claims,and payments will be released for claims that have already been approved for payment.This temporary reduction of the payment floor will result in payments being issued early (checksand electronic funds transfers (EFTs)). This may give the appearance that your cash revenues haveincreased when in fact; payments for some of your claims may have simply been made earlier thannormal. Providers are encouraged to monitor their payments and make adjustments as necessary toprevent cash flow problems during the transition period.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 21 MMR 2011-01, January 2011