Client Portal Blog

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 the high level of competence and experience Angie has demonstrated to assist our clients in their documentation and coding efforts, “  stated Dr. Schamp. “ Her unique combination of clinical nursing experience and mastery of coding knowledge positions her well in the field of coding, documentation review, Medicare compliance and revenue integrity for healthcare organizations.”

The AACCA certification process provides recognition for Angie’s ability to demonstrate her substantial understanding, knowledge and skills specific to Point-of-Care Coding and revenue integrity. The AACCA is the only organization in the United States that provides testing and certification in compliant coding and conducting chart reviews.

Sommer Huseman joins Capstone Performance Systems
posted by: in Press Releases

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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 include chart reviews and audits, staff education, and working with staff to maximize reimbursement. She has over 17 years of experience in the medical field including critical care, acute care, long term care and PACE.  Sommer’s understanding of CMS compliance, PACE documentation guidelines and ICD/ HCC coding and reimbursement will make her an asset to the organization.

“Our clients have benefitted from our documentation improvement reviews and training to assist them in both compliance and revenue,” Dr. Schamp said. “Sommer brings solid PACE experience and a strong clinical background to bolster these services.”

Sommer is from Grindstone, Pennsylvania. She is a Registered Nurse and received her BSN from California University of Pennsylvania.

Risk Adjustment Data Validation (RADV) Guidelines for Medical Record Documentation

Written by: Dr. Richard Schamp, CEO

The Centers for Medicare and Medicaid Services (CMS) perform risk adjustment data validation audits on patients’ medical records. Risk adjustment data validation (RADV) is the process of verifying diagnosis codes submitted for payment are supported by medical record documentation. The purpose is to ensure risk adjusted payment integrity and accuracy.  CMS has announced its intention to increase auditing activity consistent with an emphasis to reduce payment errors.

Signs your plan may be at risk for a RADV:

  • Large change in year-over-year risk scores – CMS will focus on plans with big increases in score to ensure it is correct
  • Very few delete records – if you are not doing deletes, you are reviewing your own submissions for accuracy and correcting errors
  • Other corrective actions – has your plan been reviewed for something else? It may increase your likelihood of audit as CMS sees you as a risk.

At Capstone Performance Systems we have some specific documentation guidelines to follow to promote compliance with CMS data validation.

  • Medical record documentation must be legible.
  • For risk adjustment data validation purposes, CMS will only consider medical record documentation from a face-to-face encounter (between a patient and physician/provider). [Note: CMS does not accept initials and a date on a lab report as adequate documentation. They also do not accept a copy of a note in the file where lab results were mailed to a patient. The condition or findings must be discussed and notated in the patient face-to-face encounter for CMS to accept this as appropriate documentation. Superbills or encounter forms and problem lists are also unacceptable types of medical record documentation to validate an ICD-9 CM code.]
  • Physician’s signature and their credentials must be included on each patient encounter, the following is acceptable: Mary C. Smith, MD or MCS, MD.  [Note: credentials must be either next to the provider’s signature or pre-printed with the provider’s name on the practice’s stationery.]
  • Electronic Signature – requires authentication by the responsible provider (for example, but not limited to “Approved by”; “Signed by”; or “Electronically signed by”. They must also be password protected and used exclusively by the individual provider.) 
  • Signature Stamp – Stamped signatures are no longer acceptable for provider documentation effective January 1, 2009.
  • Typed Signature – is unacceptable unless it is authenticated by the physician/provider. 
  • Patient’s name must appear on every page of the medical record and all entries/encounters must be dated.
  • Records must be coded in accordance with the ICD-9-CM Guidelines for Coding and Reporting. Medical record documentation must support the code selected and substantiate that the proper coding guidelines were followed. Documentation must support that condition was addressed such as status of condition, lab values, PE, symptoms, education.  Ordering labs and medications does not validate the diagnosis.
  • Code all documented conditions that coexist at the time of the visit, and require or affect patient care treatment or management.  Do not code conditions that were previously treated and no longer exist.  However, history codes may be used if the historical condition or family history has an impact on current care or influences treatment. Do not document a diagnosis as “history of” for a condition that is acute or chronic still requiring management or treatment.
  • Chronic conditions treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the condition(s). Address chronic conditions at least every 6 months.  Code all documented conditions that coexist at the time of the visit and require or affect patient treatment or management.  Even if the note states, “doing well with diabetic diet or continues to do home blood sugar monitoring,” CMS considers this notation as meeting their criteria.
  • Sign the medical record and make all notations timely. [Note: CMS expects records to be documented at the time of the visit.]  Addendums are acceptable in certain circumstances such as the following: Patient has visit for a mole removal. The pathology report is received several days after the office visit and confirms malignant melanoma. The physician reviews the findings, initials the report, and documents in the record the results and notification to the patient.  Since the removal of the mole was done during the office visit, the new code (for example,172.9) should be submitted with that date of service.
  • Unacceptable types of diagnoses.  “Probable”, “suspected”, “questionable”, “rule out” or “working” diagnoses cannot be reported to CMS as valid diagnoses by a physician or in the outpatient hospital setting.
  • Document specificity of condition.  Specify conditions as chronic, major, recurrent and type of condition such as chronic renal insufficiency, major depression, chronic hepatitis C, if the condition is chronic, major, or recurrent.
  • Linking diagnosis with manifestations.  When conditions are related, link them together in the documentation, for example, diabetes with peripheral vascular disease.  When linking conditions, include documentation to support both conditions.  Use additional diagnosis codes to identify manifestation.  If both conditions are not validated, it cannot be coded as linked.
  • Use V codes when appropriate.  Document health status conditions in notes (amputation status, transplant status, dialysis, HIV status, and artificial opening such as colostomy and ileostomy).

For more information about RADV please contact us.

 

*The information presented here complies with accepted coding practices and guidelines as defined in the ICD-9-CM coding book. It is the responsibility of the healthcare provider to produce accurate and complete documentation and clinical rationale, which describes the encounter with the patient and the medical services rendered, to properly support the use of the most appropriate ICD-9-CM code(s) according to the official coding  guidelines.

*The information presented herein is for general informational purposes for clinicians only and is not warranted that the information contained herein is complete, accurate or free from defects.

Capstone Performance Systems hires Matthew Zimmerman

BOULDER, Colo.–June 24, 2013–Dr. Richard Schamp, CEO of Capstone Performance Systems, announced that Matthew Zimmerman has been hired as a Risk Adjustment Consultant. 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.

Zimmerman brings a well-developed understanding of all aspects of enrollment and other health plan management functions that impact Medicare revenues. He also has extensive experience working with Medicare Part D management.  In his new position, Zimmerman will help Capstone clients improve their processes to avoid mistakes in RAPS (request for anticipated payment) data management. Zimmerman will play a key role in the evolving analytic services to support clients through meaningful analyses of their data.

“Matthew is an expert in all aspects of risk adjustment business processes, with skills honed in the trenches of working in a PACE environment for 13 years,” Dr. Schamp said. “He adds both depth and breadth to our team and is a rich source of experience and knowledge that will directly benefit our clients.”

Zimmerman is from Denver, Colo. He holds a double major in psychology and sociology from Purdue University.

Capstone Performance Systems selected to provide training for National PACE Association members

BOULDER, Colo.–May 8th, 2013–The National PACE Association (NPA), which represents Programs of All-inclusive Care for the Elderly (PACE) nationwide, has made an agreement with Capstone Performance Systems (Capstone) to provide assistance to NPA members. Specifically, Capstone will provide training and resources for documentation and coding procedures that will be integral to the full implementation of CMS Encounter Data Reporting System (EDRS) for PACE organizations in 2014.

Regulated by Centers for Medicare and Medicaid Services and state Medicaid agencies, PACE organizations deliver a community-based and comprehensive model of care for frail seniors who desire to live at home. Capstone works with PACE organizations to support Medicare risk adjustment and enhance performance, compliance and revenue. The training offered by Capstone for NPA members will include discipline-specific webinars to support the PACE interdisciplinary team members that utilize existing procedure codes.  Additionally, Capstone will develop a set of resources to support the NPA members’ use of procedure coding and enhanced model Superbills that will be available on the NPA website.  EDRS requires procedure codes to quantify the services provided to PACE participants and has been partially implemented in 2013 for standard health care claims.   Compliance with the full EDRS implementation requires reporting procedures for all encounters provided in the PACE centers or by PACE staff.

“Capstone is pleased to work alongside our colleagues in the PACE community to develop resources that will assist with compliance and implementation of the challenging encounter data reporting requirements,” commented Richard Schamp, M.D., CEO of Capstone Performance Systems.

 

 

Welcome to the Capstone Performance Systems Knowledge Center
posted by: in Knowledge Center

Capstone Performance System is expanding service to our clients by developing a knowledge base for your reference in regard to Risk Adjustment and related topics.  We invite clients to share this link with all interested parties in your organization (but not with outside parties).  Anyone in your organization can obtain log-in credentials.  While much of the information we post here is available elsewhere, some is proprietary.  Our main goal is to give you a single source for reference.

Resources will be available in relevant categories, such as:

  • CMS risk adjustment reference materials
  • Teaching presentations
  • FAQs regarding risk adjustment topics
  • Condition-specific monographs for documentation helps
  • General and specific ICD-9 coding guidelines and examples
  • Resources for ICD-10 training
  • Resources for CPT coding for Encounter Data Reporting
  • Links to outside resources
  • Risk Adjustment Data Validation Audits

As new material is absorbed into the Knowledge Center, we will notify you. The Knowledge Center is to serve you, our clients, so we encourage you to comment and make suggestions for resources. You can also contact us by email (info@capstoneperformancesystems.com).

We’re just getting started, but feel free to explore the Knowledge Center today.

Best Wishes,

Your Capstone Team

ICD-9
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The links below will allow you to download commonly asked for reference files that are provided here for your convenience.

 

Angie Hlad joins Capstone Performance Systems
posted by: in Press Releases

BOULDER, Colo.–October 23, 2012– Dr. Richard Schamp, CEO of Capstone Performance Systems, announced that Angie Hlad has been hired as Risk Adjustment and Coding Coordinator. Capstone Performance Systems works with Programs of All-inclusive Care for the Elderly (PACE) organizations to demystify Medicare risk adjustment and enhance performance, compliance and revenue. PACE organizations provide community-based, comprehensive care to frail seniors; they are sponsored by Medicare and Medicaid.

Angie’s responsibilities include chart reviews and audits, staff education, and working with the staff to maximize reimbursement. Before accepting her position at Capstone, Angie worked with SeniorLIFE, a PACE program in Pennsylvania. Angie’s background includes a mix of clinical and administrative experience as well as documentation, coding and reimbursement experience that will strengthen the services Capstone provides.

“I am pleased to have recruited an experienced nurse who understands the subtleties of the PACE model of care and the risk-adjusted payment system,” Dr. Schamp said. “Angie is skilled at understanding the documentation and coding requirements that support optimal compliance and payments for PACE organization.”

Angie is from Brownsville, Pennsylvania. She is a Registered Nurse and received her BSN from Waynesburg University in 2002.

Capstone Performance Systems names Richard Schamp, M.D., as CEO

BOULDER, Colo. –August 27, 2012–David Reyes, principal of Altitude Edge and partner for Capstone Performance Systems, announced that Dr. Richard Schamp has been selected chief executive officer. Capstone Performance Systems works with Programs of All-inclusive Care for the Elderly (PACE) organizations to demystify Medicare Risk Adjustment and enhance performance, compliance and revenue. PACE organizations provide community-based, comprehensive care to frail seniors; they are sponsored by Medicare and Medicaid.

According to Reyes, “Dr. Schamp comes to this role with years of experience in the PACE industry and a key understanding of the Medicare reimbursement system. Capstone clients will enjoy the benefits of his in-depth experience in the PACE environment, plus some exciting enhancements that are planned through Capstone.”

Dr. Richard Schamp is the chief executive officer of Capstone Performance Systems. He has an extensive background in primary care and geriatrics, as well as strong administrative experience in a variety of health care settings. He brings a unique combination of talents to Capstone Performance Systems, supporting PACE providers in the areas of Medicare risk adjustment, medical quality management, documentation improvement and PACE-specific primary care practices. Richard was the medical director for Alexian Brothers Community Services, a PACE based in St. Louis, Mo.

Before being selected as CEO of Capstone Performance Systems, Schamp worked with Altitude Edge Companies AEC Consulting and Peak PACE Solutions. He will continue his roles as a senior medical consultant for AEC Consulting and partner with Peak PACE Solutions. He has fifteen years private practice experience in rural Pennsylvania, where he also served on the board of directors for a rural AHEC. He was selected for a two-year rural leadership program at Pennsylvania State University.  In addition, he was faculty at the Family Medicine Residency at Forest Park Hospital as Coordinator for Geriatric Curriculum and is a clinical professor at Saint Louis University’s School of Medicine Departments of Family and Community Medicine and Internal Medicine, Division of Geriatrics. Schamp is a certified Medical Director and is a frequent speaker on topics of interest to PACE. He has served as the Chair of the National PACE Association’s Primary Care Committee and the Board of Directors for the National PACE Association.  Richard earned his Doctorate of Medicine degree from the University of Kansas.

 

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Altitude Edge forms new business, Capstone Performance Systems, for dedicated Medicare risk adjustment

BOULDER, Colo. –August 15, 2012– Altitude Edge announces the creation of Capstone Performance Systems, a team devoted solely to the increasing need for accurate Medicare risk adjustment services.

Altitude Edge has been providing risk adjustment services for several years, to Programs of All-inclusive Care for the Elderly (PACE) and similar health care organizations. PACE and similar organizations provide critical care services to seniors so they may remain safely at home.

Altitude Edge created Capstone Performance Systems to devote a complete team to the rapidly increasing need for risk adjustment. Capstone Performance Systems helps PACE and other organizations ensure they are reimbursed by Medicare accurately and fully for the services they provide. Medicare Risk Adjustment can be complicated and challenging; Capstone helps organizations understand these complexities and respond with accurate, meaningful data.

David Reyes, Principal, Altitude Edge Companies, said the time was right to create Capstone. “We have been providing excellent risk adjustment services for years, but the time has come to dedicate a complete team to this growing need. We’re excited to expand with Capstone.”

Dr. Richard Schamp, an expert in geriatric care and PACE, has been named chief executive officer of Capstone. Dr. Schamp is a certified Medical Director and was previously a frequent speaker on evidence-based medicine. He has served on the National PACE Association’s Primary Care Committee and its Board of Directors.

Altitude Edge (www.altitudeedge.com)
Formed in 2005, Altitude Edge is a unique firm that approaches the future of health care by combining solid strategic analysis and traditional tactics with ideas that help organizations’ reach their peak performance. Altitude Edge helps forward-thinking organizations that support seniors with housing or health care services, including PACE, adult day health centers, retirement communities, assisted or independent living operators, transportation providers and others. Altitude Edge has formed three companies to assist clients: AEC Consulting, Peak PACE Solutions, and Capstone Performance Systems.

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