Yearly Archives: "2013"

Medicare Part D Readiness Review – Preparation and Compliance

Medicare Part D Readiness Review – Preparation and Compliance

Submitted by: Matt Zimmerman

The importance of developing and maintaining a Medicare Part D Compliance Program, focused on adhering to PACE guidelines, cannot be overemphasized. Plans that have a strong internal auditing and monitoring program in place are reassured they are within compliance regulations. Plans on the other side of the spectrum are plagued with the stress and worry that…

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Neta Kessler hired as Project Specialist at Capstone Performance Systems

Neta Kessler hired as Project Specialist at Capstone Performance Systems

BOULDER, Colo.–November 21, 2013– Dr. Richard Schamp, CEO of Capstone Performance Systems, announced that Neta Kessler has been hired as Project Specialist. Capstone Performance Systems works with Programs of All-inclusive Care for the Elderly (PACE) and similar organizations to demystify Medicare risk adjustment methodologies and to enhance performance, compliance and revenue. PACE organizations provide community-based, comprehensive care to frail seniors; they…

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Documenting and Coding for Morbid Obesity – HCC 22

Documenting and Coding for Morbid Obesity- HCC 22

By: Dr. Richard Schamp, MD

Frequently we receive questions about documenting and coding for levels of obesity. This is because Morbid Obesity triggers an HCC and thus provides payment, which is appropriate, due to the extra costs involved in the care of the condition.  We would like to provide some clarification around this issue.

Morbid Obesity HCC 22

Several ICD-9 codes currently map to HCC 22 in the CMS-HCC v21 (as well as RxHCC 21). …

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Diabetes Mellitus Coding Guidlines

Diabetes Mellitus Coding Guidelines
Sommer Huseman, RN, Risk Adjustment and Coding Specialist

Diabetes mellitus is a condition that results when the body is unable to produce enough insulin or properly use the insulin that it does produce. The disease of diabetes is present in a significant number of patients and consumes more than $100 million in health care resources in the United States. Therefore, it is important that the guidelines for coding diabetes mellitus are understood. Correct coding of diabetes is…

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Put MEAT in Documentation for Healthy Audits

Put MEAT in Documentation for Healthy Audits

Submitted by: Angie Hlad, CRN-C, Risk Adjustment and Coding Coordinator

Complete and accurate documentation is the key for impacting quality, safety, efficacy, and data integrity.  Additionally, complete and accurate documentation helps safeguard against payment recovery from Medicare in an audit situation.

Medicare wants to ensure payments to PACE organizations match the expected costs of care.  In order to accomplish this, CMS scrutinizes health plans with both random and targeted audits for validity of diagnoses submitted.  …

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CMS Requirements for Monitoring and Auditing

CMS Requirements for Monitoring and Auditing

Submitted by: Matt Zimmerman

The importance of developing and maintaining a robust Internal Monitoring and Auditing Program focused on adhering to PACE guidelines cannot be underestimated. Plans that have a strong program in place are assured in knowing that they are within the regulations and experiencing the reassurance that compliance adherence affords. Plans on the other side of the spectrum are plagued with the stress and worry that comes with either not knowing if they…

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Correcting Diagnosis Codes Submitted for Risk Adjustment (RAPS) -Part 2

Capstone LogoCorrecting Diagnosis Codes Submitted for Risk Adjustment (RAPS) -Part 2

By: Dr. Richard Schamp, MD

Our previous article described the importance of identifying and correcting errors in submitted data such as RAPS files.  Today, we review how to correct the errors.

The Risk Adjustment Processing System at CMS allows for the correction of risk adjustment data submitted to CMS. This correction process is based on the concept that the incorrect…

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Correcting Diagnosis Codes Submitted for Risk Adjustment (RAPS) – Part 1

Capstone LogoCorrecting Diagnosis Codes Submitted for Risk Adjustment (RAPS) -Part 1

By: Dr. Richard Schamp, MD

PACE Organizations (POs) face many compliance issues regarding their data submissions to regulatory agencies.  Risk Adjustment data is just one of the many areas where care is needed.  For example, POs are required to attest annually regarding risk adjustment data accuracy.

  • MA plans must certify that risk adjustment data is accurate, complete and truthful (based…

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Angie Hlad receives credentials from the American Association of Clinical Coders and Auditors

BOULDER, Colo.–August 21, 2013– Dr. Richard Schamp, CEO of Capstone Performance Systems, announced that Angie Hlad is now credentialed by the American Association of Clinical Coders and Auditors (AACCA) as a Certified Registered Nurse (RN) Coder. Angie has worked for Capstone as a Risk Adjustment and Coding Coordinator since 2012.  She is responsible for chart reviews and audits, client education, and working with clients to maximize reimbursement.

“We are pleased at…

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Sommer Huseman joins Capstone Performance Systems

Capstone Logo

BOULDER, Colo.–June 28, 2013–Dr. Richard Schamp, CEO of Capstone Performance Systems, announced that Sommer Huseman has been hired as Risk Adjustment and Coding Specialist. Capstone Performance Systems works with Programs of All-inclusive Care for the Elderly (PACE) organizations to optimize Medicare risk adjustment processes and enhance performance, compliance and revenue. PACE organizations are sponsored by Medicare and Medicaid and provide community-based, comprehensive care to frail seniors.

Sommers’s responsibilities…

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