Medicare Risk Adjustment Archives - Capstone Performance Systems

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…

18 Jan

Diagnosing and Coding for Chronic Kidney Disease

in Articles | tagged: Angie Hlad Capstone Performance Systems CMS-HCC Risk Adjustment Coding for Chronic Kidney Disease Diagnosing for Chronic Kidney Disease Medicare Risk Adjustment

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…

16 Dec

Medicare Part D Readiness Review – Preparation and Compliance

in Articles | tagged: Capstone Performance Systems Matthew Zimmerman Medicare Part D Medicare Risk Adjustment PACE Medicare Risk Adjustment Part D 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…

21 Nov

Neta Kessler hired as Project Specialist at Capstone Performance Systems

in Press Releases | tagged: Capstone Performance Systems Dr. Richard Schamp Medicare Risk Adjustment Neta Kessler PACE Medicare Risk Adjustment

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…

01 Nov

Diabetes Mellitus Coding Guidlines

in Articles | tagged: Capstone Performance Systems Diabetes mellitus coding Medicare Risk Adjustment PACE Medicare Risk Adjustment PACE Risk Adjustment Sommer Huseman

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…

13 Sep

CMS Requirements for Monitoring and Auditing

in Articles | tagged: Capstone Performance Systems CMS Requirements for monitoring and auditing Matthew Zimmerman Medicare Risk Adjustment PACE Fraud Waste and Abuse Policy PACE Medicare Risk Adjustment part d audit RAPS

CMS Requirements for Monitoring and Auditing

Submitted by: Matt Zimmerman

The importance of developing and maintaining a robust Internal Monitoring and Auditing Program focused on adhering to PACE guidelines cannot be underestimated. Plans that have a strong program in place are assured in knowing that they are within the regulations and experiencing the reassurance that compliance adherence affords. Plans on the other side of the spectrum are plagued with the stress and worry that comes with either not knowing if they…

06 Sep

Correcting Diagnosis Codes Submitted for Risk Adjustment (RAPS) -Part 2

in Articles | tagged: Capstone Performance Systems Dr. Richard Schamp Medicare Risk Adjustment PACE Medicare Risk Adjustment PACE Risk Adjustment RAPS Risk Adjustment Processing System

Correcting Diagnosis Codes Submitted for Risk Adjustment (RAPS) -Part 2

By: Dr. Richard Schamp, MD

Our previous article described the importance of identifying and correcting errors in submitted data such as RAPS files. Today, we review how to correct the errors.

The Risk Adjustment Processing System at CMS allows for the correction of risk adjustment data submitted to CMS. This correction process is based on the concept that the incorrect…

28 Aug

Correcting Diagnosis Codes Submitted for Risk Adjustment (RAPS) – Part 1

in Articles | tagged: Capstone Performance Systems Correcting diagnosis codes Dr. Richard Schamp Medicare Risk Adjustment PACE Medicare Risk Adjustment PACE Risk Adjustment RAPS

Correcting Diagnosis Codes Submitted for Risk Adjustment (RAPS) -Part 1

By: Dr. Richard Schamp, MD

PACE Organizations (POs) face many compliance issues regarding their data submissions to regulatory agencies. Risk Adjustment data is just one of the many areas where care is needed. For example, POs are required to attest annually regarding risk adjustment data accuracy.

MA plans must certify that risk adjustment data is accurate, complete and truthful (based…
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21 Aug

Angie Hlad receives credentials from the American Association of Clinical Coders and Auditors

in Press Releases | tagged: AACCA American Association of Clinical Coders and Auditors Angie Hlad Capstone Performance Systems Medicare Compliance Medicare Risk Adjustment PACE chart audit PACE chart reviews PACE documentation review PACE Medicare Risk Adjustment PACE Risk Adjustment revenue integrity

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…

27 Jun

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

in Articles Press Releases | tagged: Capstone Performance Systems CMS RADV Auditing Dr. Richard Schamp Medicare Risk Adjustment PACE Medicare Risk Adjustment RADV RADV Documentation Guidelines Risk Adjustment Data Validation

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…

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Tag Archives: "Medicare Risk Adjustment"

Documentation and Coding for Chronic Heart Failure in PACE

Diagnosing and Coding for Chronic Kidney Disease

Medicare Part D Readiness Review – Preparation and Compliance

Neta Kessler hired as Project Specialist at Capstone Performance Systems

Diabetes Mellitus Coding Guidlines

CMS Requirements for Monitoring and Auditing

Correcting Diagnosis Codes Submitted for Risk Adjustment (RAPS) -Part 2

Correcting Diagnosis Codes Submitted for Risk Adjustment (RAPS) – Part 1

Angie Hlad receives credentials from the American Association of Clinical Coders and Auditors

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

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