HEALTHCARE INTEGRATED GENERAL LEDGER ACCOUNTING SYSTEM (HIGLAS) Association of Government Accountants – DC Chapter Conf

1. HEALTHCARE INTEGRATED GENERAL LEDGER ACCOUNTING SYSTEM (HIGLAS) Association of Government Accountants – DC Chapter ConferenceMay 9, 2007

2. George E. Jenkins, CPA, MBA Deputy Director, Financial Management Systems Group Office of Financial Management Centers for Medicare and Medicaid Services Department of Health and Human Services “Modernizing the Agency and Transforming Healthcare”

3. CMS Vital Statistics “CMS - Modernizing One of The Largest Healthcare Purchasers In The World!” • Over 1.2 billion Medicare claims are processed each year. • Medicare enrollment includes approximately 44 million beneficiaries and is growing. • CMS is one of the largest purchasers of health care in the world and represents 33 cents of every dollar spent on health care in the United States.

4. What is HIGLAS? Healthcare Integrated General Ledger Accounting System(HIGLAS) HIGLAS provides CMS a uniform financial management system to account for over $600 billion spent in outlays for healthcare each year. • Oracle Federal Financials was selected by CMS as the base COTS application to improve the Agency’s ability to manage the benefits and administrative accounting functions.

5. HIGLAS Program Vital Statistics To date, HIGLAS produced the following: • $138.2 billion in Medicare Benefit Payments (As of April 24, 2007) • 284.6 million Claims Processed (As of April 24, 2007) • $5.2 billion of AR/AP netted funds (Through March 2007) • $36.3 million Interest earned in the trust funds (Through FY06)

6. Benefits Realization • Implemented COTS-Based Dual-Entry Accounting System (Meets Federal Standards) • Recoups Medicare Overpayments through Netting • Improves Collection of Debts • Savings as of January 2007: • Preserved $4.58 Billion in Medicare Trust Funds • Earned additional interest ($36.3M) in the Medicare Trust Funds (through FY06) • Other Savings and Benefits : • Fewer Improper Payments - Decreases the need for Recovery Actions (Less “Pay and Chase”) • Reduced Costs due to Decommissioned Cuff Record Systems • HIGLAS provides FFMIA Compliance & supports DHHS Compliance • Improvements in Automated Debt Collection/Referral Activities • Creates Audit Trails for every Transaction/Payment/Claim in HIGLAS • Improves Financial Audit Ability

7. Functionality Analysis for Integration -as an example… Current Environment HIGLAS Environment Shared System - FISS Shared System - FISS Claims Adjudication Claims Adjudication 837 Adjudicated Claims 835 Remittance Info FISS Financial Module Accounts Payables Accounts Receivables Generate Payment HIGLAS Accounts Payable Netting Accounts Receivable Cuff Systems CFO Reports 750/751 Integrated Financial Reports General Ledger Double Entry Accrual Accounting No Transactional Accounting Integrated Financial Reporting No General Ledger Single Transactional System Multiple Cuff Systems Detail Accounting Audit Trail No Financial Integrity

8. General Ledger Business Processes –as an example… Set of Books Accounts Payable • Process Automated/Manual Journals • Process Recurring Journals • Automatic/Manual Journal Reversals • Manually Post Journals • Schedule Journal Posting • Daily Reconciliation Process • Maintain Accounting Calendar • Process GL Month End Close • Process GL Year End Close • Generate Period End Reports and Queries Accounts Receivable General Ledger Journals Manual Journals Posting Calendar Reporting

9. Multiple Users within HIGLAS Medicare Contractor A Medicare Contractor B Medicaid, Other Admin. Programs FISS / MCS Allotment, Pay & Monitor Pricer & Claims Adjudication Pricer & Claims Adjudication HIGLAS Accounts Payable Accounts Receivable Accounts Payable Accounts Receivable Accounts Payable Accounts Receivable Other Accounts Workload B Workload A CMS Integrated General Ledger Financial Reporting CMS Financial Reporting

10. HIGLAS Release 1 – Oracle Solution Modules Oracle Federal Financials - Release 11i Third-party Integration Application Modules Application Foundation In/Outbound Staging Enterprise Application Integration Trading Community Architecture (TCA) 835 Remittance Advice 271/274 Provider/ Beneficiary 837 Adjudicated Claims Extended Functionality Scheduler Multi-Org Application Security Content Manager Accounts Receivable Accounts Payable Loans Audit Trail File Transfer Concurrent Processing Cash Management Federal Administrator General Ledger Online Screens & Reporting Archive & Restore

11. HIGLAS Release 1 -Financials & HTB Integration HIGLAS Oracle eBusiness Suite - Release 11i Application Foundation Application Modules Staging Trading Community Architecture (TCA) 835 Remittance Advice 271/274 Provider/ Bene. 837 Adjudicated Claims Multi-Org Accounts Receivable Application Security Accounts Payable Healthcare Transaction Base (HTB) Audit Trail ETL Concurrent Processing Document Summary General Ledger Extended Functionality Cash Management Online Screens & Reporting

12. HIGLAS Technical Operations AUDITS • External Audits • CFO EDP • Circular A-123, Job Mapping • Security Testing and Evaluation • Internal Audits • NESSUS • Vulnerability Assessment • Roles and Responsibilities • System Integrator • System Users • POA&M

13. HIGLAS Access Job Roles, Responsibilities, and Job Role Constraints

14. Basic Design for Access • Functionality and Access is assigned based on the various HIGLAS Modules or Job Role Categories • Accounts Payable • Accounts Receivable • General Ledger • Cash Management , Bank Information • Loans Management • Audit • AR Collections • General Ledger • Third Party Payments (TPP) • Federal Administration • Healthcare Transaction Base (HTB)

15. Functionality • Within the modules you either have Update or Inquiry Capability • The capability is determined by what Job Role is assigned to you • Each job role has associated responsibilities and each responsibility provides specific functionality. It is a tiered approach.

16. Functionality Outline Tiered Approach – AP Module • Update AP Payments • Add Update Inquire AP Payments • Add and Update AP Payments • Inquire AP Payments, payment batches form, payments form, payment overview form and withheld amounts form • View Accounting Lines • AP Setup Inquiry • Control Payables Periods Inquiry • Open Interfaces Invoices Inquiry • Run and View Selected AP Reports

17. AP Module

18. Update AP Payments • Add Update Inquire AP Payments • Provides access to view, update, and add claim payment data in the AP module and drill down capability to the invoice information. • Provides access to run selected standard and custom AP reports. • Add Update Inquire AP Invoices • Provides access to view, add, and update invoice claim information in the AP module. • Provides access to run selected standard and custom AP reports.

19. Update AP AR Customer /Supplier Add • Add Update Inquire AP Suppliers • Provides access to view, add and update Provider / Beneficiary / Employee / Insurers data in the AP module. • Provides access to run selected standard and custom AP reports. • Add Update Inquire AR Customers • Provides view, update and add capability to Provider / Beneficiary / Employee / Insurers data in the AR module. (Quick Standard and Summary Customer Forms, and Customer Profile Classes). • Provides access to run selected standard and custom AR reports.

20. Job Role Constraints • Part of our Job Role Functionality Outline is the Job Role Constraints Section. • A work group reviewed the Job Roles and Responsibilities and developed a listing which indicates how to provide access without compromising segregation of duty requirements.

21. Access To Update AP Payments Add and update claim payment data in the AP module or Access To Update AP Invoices Add and update invoice claim information Access To Update AR Apply Receipts /AR Transactions Add update receivable transaction data Apply /reverse receipts (e.g. apply cash receipt to a receivable) Should Deny Access To Update AP AR Customer Add or Update AP Supplier Address or Update AP Supplier EFT or Update Banks Update AR Receipts Add update cash receipts in AR module, but can’t apply/reverse the receipt to an AR. Job Role Constraints

22. Job Roles, Responsibilities, and Job Role Constraints • The Job Role and Responsibility Matrix was used to create the Job Role Functionality Outline. • This document outlines the Job Roles, Responsibilities, and associated functionality. It also defines Job Constraints in a format that is easy to read and understand. • The contractors determine access needs based on the functionality as defined by the job roles.

23. Job Role Constraints

24. Job Role Constraints Update AP Payments • Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Banks Update AP Invoices • Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Banks Update AP AR Customer/Supplier Add • Non-Manager Job Role Constraints: Should not have Update AP Invoices or Update AP AR Collections / Refunds or Update AP Payments or Update AP CM Recon or Update AP Supplier EFT or Update Banks or Update Interface AP Invoices or Update CM

25. Job Role Constraints Update AP AR Collections / Refunds • Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Banks or Update AR Receipts Update AR Apply Receipts / AR Transactions • Non-Manager Job Role Constraints: Should not have Update AR Receipts Update AP CM Recon • Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Interface AP Invoices or Update Banks or Update GL

26. Job Role Constraints Update AR Receipts • Non-Manager Job Role Constraints: Should not have Update AP AR Collections / Refunds or Update AR Apply Receipts / AR Transactions Update GL • Non-Manager Job Role Constraints: Should not have Update CM or Update AP CM Recon Update Banks • Non-Manager Job Role Constraints: Should not have Update AP Payments or Update AP Invoices or Update AP AR Customer/Supplier Add or Update AP AR Collections / Refunds or Update AP CM Recon or Update AP Supplier Address or Update CM or Update AP Supplier EFT or Update Interface AP Invoices

27. Job Role Constraints Update AP Supplier Address • Non-Manager Job Role Constraints: Should not have Update AP Invoices or Update AP AR Collections / Refunds or Update AP Payments or Update AP CM Recon or Update AP Supplier EFT or Update Banks or Update Interface AP Invoices or Update CM Update CM • Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Interface AP Invoices or Update Banks or Update GL

28. Job Role Constraints Update AP Supplier EFT • Non-Manager Job Role Constraints: Should not have Update AP Invoices or Update AP AR Collections / Refunds or Update AP Payments or Update AP CM Recon or Update AP AR Customer/Supplier Add or Update Banks or Update Interface AP Invoices or Update AP Supplier Address or Update CM Update Interface AP Invoices • Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP CM Recon or Update AP Supplier EFT or Update Banks or Update AP Supplier Address or Update CM Loans Agent • Non-Manager Job Role Constraints: Should not have Loans Manager