Tag Archives: "PACE Risk Adjustment"

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

Capstone LogoCorrecting 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…

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

Capstone LogoCorrecting 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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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…

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