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Risk Adjustment Advisor
July 2015: Heating Up for ICD-10!
With ICD-10 only a couple months away, Capstone understands the pressure that PACE programs are under. We have been working diligently to create training and technological strategies to ensure our clients are fully supported. Much of this month's newsletter is focused on those strategies, as well as other tips for implementation success.

Matt Zimmerman

RA Consultant

Risk Adjustment Today:
Importance of External Provider Documentation to Validate RAPS Data

With the most recent sweep of RAPS data completed, now is the time to re-validate the accuracy of calendar year 2014 RAPS data. Ensuring that proper medical record documentation is on file and readily available is a large part of validating RAPS data accuracy. While the focus is most certainly on internal documentation, external provider documentation should not be overlooked.  (continue reading)

Richard Schamp, MD


  Progress Notes: A Note About ICD-10

  Dear Friends and Colleagues,


  Over the past few weeks we have had numerous inquiries     
  about assistance to achieve readiness for ICD-10, which is 
  currently scheduled to be required for all HIPAA-covered 
  entities' healthcare transactions on October 1, 2015.  With only
  73 days to go, providers and PACE organizations can still do
  much to prepare effectively.  Here are the top
  recommendations we've seen:


  1.  Take advantage of the numerous resources available to your providers and staff through local hospitals, health systems and national organizations.  Most professional societies provide valuable resources (some with a cost), but CMS and WHO training materials are generally free.
  2. Capstone is sponsoring a webinar series that covers essential ICD-10 introduction with documentation and coding information regarding the most common conditions seen in the PACE population.  This should be valuable in alerting providers to potential trouble spots in their documentation patterns.  The webinars are free, but do require registration.

  3. For programs that are already Capstone risk adjustment retainer clients, we will be coming on site over the next few weeks to provide additional training in ICD-10 with emphasis on documentation improvement.

  4. Finally, the question of whether to use a professional coder always comes up.  We think that some programs are well-positioned to survive without a coder, using existing EMR technology and provider training.  Others don't wish to add to provider burden or may have marginal capacity for documentation or coding enhancement.  For those programs, hiring the right kind of coder or using a coding service makes sense.

  5. If organizations use third parties to submit diagnosis codes for RAPS or encounter data, be sure that these submitters are prepared for ICD-10

  6. Finally, after October 1, we recommend a robust auditing process to review/assess the documentation and coding outcomes and to identify vulnerabilities that need to be addressed yet in 2015 and certainly in 2016.

Contact us if you have questions. We are here for you.


All good wishes,


Richard O. Schamp, MD

The ABD's of Medicare:
ICD-10 is on the Way


There is certainly considerable angst throughout the PACE community as implementation of ICD-10 looms overhead. As you know, Capstone is sponsoring a series of webinars to address documentation and coding in ICD-10 common conditions seen in PACE.

However, as part of Capstone's desire to help our clients develop a level or comfort with ICD-10, we are making a sincere effort to visit each of our clients for a special one on one training session in ICD-10. Though the expansion of codes and the significant increase degree of specificity makes ICD-10 a little intimidating, I think you will find that there is a great deal of logic in how the system is arranged, and in short order you will become comfortable in the coding system.

 Documentation Dispatch: ICD-10 Overview

Angie Hlad, CRN-C

RA & Coding Dept Manager


One of the best things you can do for ICD-10 is be as prepared as possible. There are many free ICD-10 web trainings available and Capstone will be providing its own ICD-10 webinar series beginning July 23, 2015. Please check your email regarding information to register for these webinars making sure to check junk and spam mail.

Some of the changes from ICD-9 to ICD-10: (continue reading)

Product Spotlight: GuarDX Front-End Coding


Why not take the burden of coding off your shoulders by letting our team of registered coders and nurse-coders to it for you? With eight new programs starting already this year already, GuarDx is by far our fastest growing service and we continue to receive very high reviews from our clients. You can read more about this service by visiting our website, or contact us today for more information on how we can help you get started!

If you haven't already registered for the free ICD-10 webinar series, please do so today-space is limited! The first session, 'An Intro to ICD-10' is scheduled for this Thursday, July 23rd at 3:00pm EST. Programs in North Carolina can also register for this event on the NCPA website.  

Also, all of our clients will be receiving an email within the next couple weeks to schedule an onsite training visit. This training will be specifically focusing on ICD-10 and completed prior to October 1. Your prompt response to this email is greatly appreciated, as it helps us coordinate our visits in the most cost-effective way for your program.

Neta Kessler
Operations Manager
Capstone Performance Systems
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