Articles

Nominations for 2019 Richard O. Schamp, MD, Award Now Open

Capstone Performance Systems is now accepting nominations for the 2019 Richard O. Schamp, MD, Award. The Award is presented annually to a PACE Medical Director who espouses the many principles Dr. Schamp championed. David Wenzel, DO, of Midland Care was the inaugural 2018 recipient.

This year, nomination for the award is open to any PACE Medical Director whose organization is a client of a CareVention HealthCare company (Capstone, CareKinesis, Cognify, Mediture, and PeakTPA/eClusive). The criteria to be used in selecting…

02 May

CMS Announces Changes to HCC Payment Model for 2020

in Articles CMS Information ICD-10 Coding Newsletter | tagged: CMS-HCC Risk Adjustment Medicare Risk Adjustment PACE Medicare Risk Adjustment Risk Adjustment

On April 1, the Centers for Medicare & Medicaid Services (CMS) released the Final Announcement outlining changes to the HCC Payment model for Medicare Advantage Plans and PACE Programs for Payment Year 2020. The HCC model used to calculate risk scores for PACE will change from the version used since 2012 (Version 21) to the 2017 model known as Version 22.

George H. Brett, MD Chief…

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19 Jul

Dr. Indira Kanouka Joins Capstone Performance Systems’ Consulting Team

in Articles Newsletter Staff Uncategorized

Indira Kanouka, MD

Indira Kanouka, MD, has joined Capstone Performance Systems’ consulting team. A private practice physician in New Jersey, Dr. Kanouka had previously served as medical director of Beacon of Life, a PACE (Program of All-inclusive Care for the Elderly) organization, and of Specialty Hospital of Central Jersey.

Dr. Kanouka has extensive experience working with the geriatric population,…

18 Jul

Kim Browning Joins TRHC and Capstone Performance Systems

in Articles Newsletter Staff Uncategorized

Kim Browning, CHC, PMP, has joined Tabula Rasa HealthCare (TRHC) as Executive Vice President (EVP) responsible for subsidiary company Capstone Performance Systems and its new division, Peak Health Plan Management, which resulted from Capstone’s recent acquisition of Peak PACE Solutions, an Altitude Edge company.

Kim Browning

Most recently, Ms. Browning was EVP of Cognisight, LLC, in…

18 Jul

Peak PACE Solutions is Now Part of Capstone

in Articles Newsletter Peak Health Plan Management Staff Uncategorized | tagged: PACE health plan management

On May 1, Tabula Rasa HealthCare (TRHC), parent company of Capstone Performance Systems, acquired Peak PACE Solutions from Altitude Edge (AE), following the news of AE founders’ David Reyes and Ronda Hackbart retirements. Peak PACE Solutions is now Peak Health Plan Management Services and will operate as a service of Capstone.

“Capstone’s mission is to help our client organizations succeed fiscally in a compliant manner,” said Capstone CEO Richard Schamp, MD. “Having worked collaboratively for years with Peak, we look…

18 Jul

CMS Notifying PACE Plans of Next Round of 1/3 Part D Financial Audits

in 1/3 Part D Financial Audit Articles CMS Information Newsletter Uncategorized | tagged: 1/3 audit part d audit

By Matt Zimmerman
Director of Client Success/Part D Consultant

It’s that time of year again! We have been advised that CMS is in the process of notifying PACE plans of their selection for the next round of 1/3 Part D Financial Audits. Selected plans will receive a notice from the CPA contracted to conduct this year’s audits shortly. If your plan is selected for this round of Part D financial audits, the audit team will be focusing on Payment Year 2017….

18 Jul

Documenting Major Depressive Disorder

in Articles Clinical Documentation Excellence Coding ICD-10 Coding Newsletter Uncategorized | tagged: Coding major depressive disorder coding MDD Documenting major depressive disorder documenting MDD

By Denise Wills, CPC-A

When documenting depression, accuracy is important in determining the most specific code. If incomplete documentation is received, it will result in an unspecified code selection, which does not map to an HCC. For example, ICD-10 code F32.9 (MDD, single episode, unspecified) does not map to an HCC, whereas F32.0 (MDD, single episode, mild) does.

The ICD-10 classification of Mental and Behavioral Disorders, developed in part by the American Psychiatric Association, classifies depression by code. Documentation of Major…

03 May

Peak PACE Solutions to Join Capstone Performance Systems

in Articles Press Releases | tagged: PACE health plan management Peak health plan management Peak PACE Solutions

Acquisition will expand TRHC’s presence in PACE market

St. Louis, MO, and Moorestown, NJ, May 3, 2018 – Tabula Rasa HealthCare (NASDAQ:TRHC), a healthcare technology company offering comprehensive data-driven software solutions and services for healthcare organizations, today announced it has acquired Peak PACE Solutions, the leading health plan management solutions and services provider in the PACE (Program of All-inclusive Care for the Elderly) market. Peak PACE Solutions will become Peak Health Plan Management Services, and operate as a…

05 Apr

Progress Notes: Provider Education and Support

in Articles Clinical Documentation Excellence Newsletter | tagged: clinical documentation RADV audit

By Richard Schamp, MD
CEO

Richard Schamp, MD, CEO

In our last edition, I mentioned the burgeoning new competency for physicians and other clinical providers – clinical documentation excellence. Let’s delve further into some specifics around the kinds of competence required in a risk-adjusted payment model. CMS has a process to verify that diagnosis codes reported that are relevant for payments in the HCC (Hierarchical Condition…

05 Apr

It’s That Time of Year: The HOS-M Survey is Coming

in Articles CMS Information Newsletter | tagged: CMS FF CMS Frailty Factor HOS-M survey

By George “Mike” Brett, MD
Senior Vice President of Consulting and Chief Medical Officer

George “Mike” Brett, MD
Senior Vice President of Consulting and Chief Medical Officer

In addition to demographic information and HCCs, a portion of a PACE participant’s risk score is derived from the Frailty Factor (FF). Eligible participants in PACE have the FF added to their risk score because the…

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Peak PACE Solutions to Join Capstone Performance Systems

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