Capstone has several staff that will be coordinating efforts to achieve the best possible outcomes for your organization this year. Under the general coordination of Neta Kessler, these services are described as:
1. An in-depth revenue cycle gap analysis to examine over 60 elements in eight major categories affecting all aspects of revenue generation. Matt Zimmerman is one of our consultants who provides a wealth of insight and information regarding health plan management. This service is directed primarily to finance and accounting staff.
2. Training visits for on-site intensive coaching, report reviews and supports related to risk adjustment. These may multiple Capstone staff, directed by either Dr. Schamp or Dr Brett, and primarily directed toward finance and clinical staff.
a. Overview of risk adjustment principles, model changes
b. Detailed analyses of plan-level and site-level data
c. Comprehensive documentation improvement and coding workshop
3. Chart Audits for documentation completeness and accuracy and to drive educational efforts. Will be done by ______________, under the coordination of Angie Hlad, CRN-C
a. Chart audits consisting of all active Medicare case records reviewed:
i. Chart audits will prioritize records based on score change, high score, dates or other targets as determined by client and/or staff recommendations.
ii. Targeted review of comprehensive assessments for which RAPS data has been submitted.
iii. All diagnoses and codes reviewed for selected assessments to ensure the following have been addressed:
1. Does documentation support submitted diagnosis codes?
2. Were submitted codes accurate and complete?
3. Were diagnoses present that were not submitted?
4. What additional diagnoses are likely to exist but were not submitted?
b. All reviews tracked in proprietary database and reported to client
c. Chart audit results inform the training visits and case-review webinars below
4. Training webinars- to review the results from chart audits with your staff. Directed by Angie Hlad, CRN-C, these reinforce the trainings received on-site.
a. Case reviews, focusing on documentation improvement for assessments/reassessments
b. 45 – 50 minutes, scheduled as needed
c. Content is focused on relevant topics based on gaps identified
5. RAPS and other data analyses and communications to facilitate timely, complete and accurate data submissions
a. HCC Opportunity (HOpp) report to identify dropped or suspect HCCs from previous period encounters for March, September, and end-of-year deadlines and
b. Plan-level, provider/site-level analyses – comparing the program to all PACE programs and investigating historical trends
c. Participant-level analyses for risk score
d. Data integrity analysis – for completeness, lag times, provider types
e. Summary analyses for prior years to predict reconciliations
f. Year-to-date analyses.
g. Detailed follow-up training related to revenue cycle gap analysis as needed.