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

HIGLAS Transition ActivitiesOn February 9, 2011, National Government Services will run the last MCS payment cycle and begin theHIGLAS transition. (See National Government Services HIGLAS Transition Timeline below.)• Waiver of the payment floor will result in claim payments (checks and EFTs) being issued earlier thannormal.• Providers are encouraged to continue submitting claims as normal.• Following our transition to HIGLAS, National Government Services will resume normal scheduledpayments.• Distribution of Remittance Advices (RAs) will resume the week of February 14, 2011.HIGLAS Remittance AdvicesNational Government Services will not be issuing payments from February 10 through February 14, 2011.Electronic remittance advices (ERAs) and paper RAs will not be available. National Government Serviceswill resume normal payment cycles and issuance of payments on February 15, 2011, at which timeproviders will be able to retrieve their ERAs.National Government Services HIGLAS Transition TimelineDateActionFebruary 9, 2011Release payments for all claims already approved to payFebruary 9, 2011Last MCS payment cycle (payment floors reduced to zero)February 10, 2011 HIGLAS transition beginsFebruary 10 throughFebruary 14, 2011February 14, 2011February 15, 2011February 14, 2011February 14, 2011through February 28,2011No payments will be issued - ERAs and paper RAs are notproducedHIGLAS transition completed – payment floors reinstatedProduction & distribution of ERAs and paper RAs resumeBegin processing backlogged files and issuing paymentsProviders may experience a significant reduction in paymentsdue to the early claim payments issued immediately prior to thetransition. Providers need to monitor and manage their cashflows during this time period.Changes Providers Will See as a Result of HIGLASClaim Payments Less than $1Current CMS instructions require carriers to hold claim payments of less than $1 until another paymentgreater than $1 is generated and then to combine the two payments. Payments less than $1 will now beissued because HIGLAS functionality at this time will not suppress these payments.Claims and Refund Payments Subject to a Hold, e.g., Do Not Forward (DNF), Bankruptcy, andPayment SuspensionProviders may be placed on a hold due to a forwarding address, bankruptcy, and payment suspension.Currently, the holds are applied to the net payment after any eligible overpayment receivables have beenoffset. In HIGLAS, the holds will be applied at the claim level. As a result, the held money will not beapplied to eligible receivables until the hold has been released.Claims and Refund Payments Subject to Third Party Payer (TPP) Offset, e.g., IRS Backup WithholdingA provider payment may be subject to offsetting to a third party, such as the IRS. In the currentenvironment, when a provider is subject to TPP, a provider check is pulled and the payment is remittedCPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 22 MMR 2011-01, January 2011