PACE Organizations sometimes find that circumstances conspire such that all diagnosis data does not get completely or accurately submitted. This situation invariably leads to sub-optimal revenues and tends to repeat itself. Capstone can help by performing retrospective reviews of records to identify documented diagnoses that were not submitted for RAPS.

Medicare timely filing requirements allow for data to be submitted up to thirteen months after the close of the data period. This means, for example, documentation for dates of service in 2013, which provide diagnosis data for Payment Year 2014 may have diagnoses that can be submitted for RAPS purposes until January 31, 2015. These codes will be incorporated into the final model run and generate a reconciliation payment mid-2015 for all of 2014.

A retrospective review may be considered if a PACE organization discovers that a significant proportion of diagnoses may not have been submitted for any reason. Our review will identify submitted diagnoses and provide the PACE organization a file of valid diagnosis codes and visit dates that may be used to correct the missing data. We will provide an impact analysis to determine what additional revenues are generated.

This service is priced as a contingency model, with the PACE organization keeping at least 80% of all recovered revenue.