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Risk Adjustment Advisor

We are delighted to present our newsletter, 'Risk Adjustment Advisor.' This monthly missive will contain important information selected to support members of your program's executive, administrative, coding, and medical staff. 'Risk Adjustment Today' written by our Risk Adjustment and Part D Consultant, Matt Zimmerman, features updates related to our various analytic reports, CMS, Part D, and other RA related information. 'Progress Note' will provide relevant industry information and company updates from expert Dr Richard Schamp. 'Documentation Dispatch' highlights tips and techniques for navigating frequently-seen challenges by our nurse-coders. Occasionally we will feature a section highlighting  products and services called 'Service Spotlight' designed to help your program achieve new levels of success. 'On Target' will feature clients that illustrate exemplary practices.

Risk Adjustment Today: The Importance of Internal Monitoring and Auditing In PACE

A robust internal process at your plan focusing on Internal Monitoring and Auditing is vital in many areas of your PACE business model. A consistent monitoring process will assist in ensuring proper payments from Medicare and assist in confirming payment accuracy to contracted vendors. Remember that all plans are required by CMS to monitor first tier, downstream and related entities (FDR) for accuracy and completeness. Taking time now to review and assess your current internal monitoring and auditing policy and procedure will provide stability and fulfillment for years to come. 

July,7 2014


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Progress Notes:
By now, most of you have heard that Capstone has new owners - Tabula Rasa Healthcare Inc.  Tabula Rasa is a group of companies devoted to optimizing healthcare in high-risk populations. You'll be learning more about that in the future, but the important thing is nothing has changed as far as Capstone's commitment to our clients.  We continue to work closely with Altitude Edge companies to collaborate in bringing high quality support to PACE and other health care organizations nationwide.  

We have significant staffing changes and additions (see this month's Press Release) in the past few weeks.  Neta Kessler has been promoted to Operations Manager. Our coding team welcomes two RN coders - Malissa Bolish, RN and Katina Yablinsky, RN.  Dr. Mike Brett has joined us as Senior Medical Consultant, bringing a wealth of clinical and PACE experience.  And Michelle Wagner is now applying her administrative skills in our home office.  We are delighted with the depth and breadth of our team and their eagerness to serve!


On Target:
The LIFE Programs of Lutheran SeniorLife Western PA

"The providers at LSL have exemplary documentation and continue to improve in coding and capturing of diagnoses. Their willingness to learn has created an optimal environment to continue to provide training in Risk Adjustment and ICD-9 coding." -A Hlad 

Thank you LIFE Programs of Lutheran SeniorLife!
Documentation Dispatch:
Capstone has recently revised the chart audit report into a format that is easier to navigate. We provided a series of webinars in June to review this process and hope that you are find them beneficial.   You would have received this new format with your May chart audit reports.   Please feel free to provide feedback on the functionality of these reports or otherwise.
Product Spotlight: Part D Consultation

At Capstone Performance Systems we know that maintaining compliance with all Part D regulations is a full time and often stressful job for both new and existing PACE plans. We are here to help with our Part D Consultation service. Our unique, intensive and customer focused process will assess the relative strength or weakness within your Part D processes by reviewing 8 key areas within the Part D process. Areas include Bid Submission, Internal Monitoring and Auditing, Part D Audit Readiness, Bid Reconciliation and several other areas of your Part D process. Starting with an on-site assessment to assisting in Part D process development after the review we are here to help.

For more information on compliance program guidelines, you can also visit the CMS website.

Contact us today for more information on how we can get started on your Part D Consulation.  

We hope you have enjoyed this new feature. Please feel free to email us  any suggestions or questions. If you are a current Capstone client, be on the lookout for another email blast feature, 'Alerts', which will be sent to targeted groups for any breaking information that needs to be read and acted on immediately. This is just another way that Capstone is ensuring that your program is being supported. Be sure to forward this to anyone in your program who isn't on our mailing list and encourage them to add themselves, for future newsletters. 

Best Regards,   

Neta Kessler MS
Operations Manager
Capstone Performance Systems

Next Month: The new 'face' of Capstone.
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