Tag Archives: "Capstone Performance Systems"

Clinical Documentation Improvement in PACE

Capstone LogoClinical Documentation Improvement in PACE

By: Dr. Richard Schamp, CEO

Clinical documentation is at the core of every healthcare encounter. Therefore it should be complete, precise, and reflect the diagnoses as well as the scope of care and services provided.  Assuring consistency in provider documentation that is accurate, specific, legible and timely represents a challenge for many organizations.

Providers (doctors, nurse practitioners, therapists and others) are trained in clinical documentation, but often…

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Documentation and Coding for Chronic Heart Failure in PACE

Documentation and Coding for Chronic Heart Failure in PACE

By: Sommer Huseman, RN, Risk Adjustment and Coding Specialist

Participants often enter PACE with limited understanding of their conditions and some have been treated for CHF without explicit awareness.  This treatment may be camouflaged by clinical setting – overlapping treatment of hypertension or renal conditions or a tendency for clinicians to downplay the diagnosis by referring to “pump problems” or other descriptions.  The astute practitioner will have a high index of suspicion…

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Diagnosing and Coding for Chronic Kidney Disease

Diagnosing and Coding for Chronic Kidney Disease

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

Chronic kidney disease (CKD) is the gradual, and often permanent, loss of kidney function.   It is a progressive condition  that can result in significant morbidity and mortality.  The condition is common in the elderly , and impacts the PACE population.  Nearly 50% of individuals over 70 years old meet the definition of CKD…

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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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