Centers for Medicare and Medicaid Services

Most Medicare Contractors, which are mainly private insurance companies, do not all use double entry accounting methods for Medicare claims accounting.  As a result, financial data has to be entered and verified manually, which increases the risk of administrative and operational errors and misstatements. 

Weaknesses such as these in Medicare claims accounting, which were documented in the General Accounting Office (GAO) and other independent audit findings, signaled the need for a new approach.  A single integrated general ledger accounting system for use across CMS and its Medicare Contractors was needed; one that would eliminate inefficient, labor intensive manual processes and provide timely and accurate financial data.

After analyzing and evaluating potential solutions, CMS determined that HIGLAS was an optimal system for meeting Medicare's financial management needs.

The Healthcare Integrated General Ledger Accounting System (HIGLAS) is a new dual-entry accounting system that replaces and modernizes 52 Medicare Contractor accounting systems with a single standardized system.  In addition to processing Medicare claims, HIGLAS will replace the legacy Financial Accounting and Control System (FACS), which accumulates CMS' financial activities, both programmatic and administrative, in its general ledger.  HIGLAS is a component of the Department of Health and Human Services (DHHS) Unified Financial Management System (UFMS).

Using a proven quality and Lean Six Sigma methodology the SEKON / ASRCC Team has been able to provide valuable insight and recommendations to the project management team to help identify and curtail potential roadblocks to the projects success.

Anticipated benefits of this project includes:

• Improve accountability for Medicare's payments to physicians, hospitals, and other providers servicing Medicare beneficiaries.
• Eliminate redundant accounting systems
• Allow more timely and effective collection activities on outstanding debts
• Pay nearly 3 Million healthcare claims a day
• Result in estimated annual cost savings of approximately $121 Million
• Meet government financial regulations including the Joint Financial Management Improvement Program (JFMIP) and the  Federal Financial Management Improvement Act of 1996 (FFMIA)