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Risk Adjustment Advisor
September 2015: Mark Your Calendars!
While the clock is winding down for the switch to  ICD-10, not far behind is the 2015 National PACE Association fall conference. Capstone's theme this year is: 
'Look Deeper, Reach Higher' 

Not only is this something that we try to help our clients achieve, but it is something we push ourselves, and our company, to do every day. One way, is by trying to find new and innovative ways to help PACE programs. When it came to deciding on a sponsorship, we knew that the launch of the new social event app through Whova, would fit this goal. Through the app, users will be able to get the most current event updates, follow the schedule of sessions & activities, network with other attendees, and take advantage of many other features to help make the most of their conference experience. On Capstone's 'Sponsor Spotlight' page, we will have links to our ICD-10 resources, and you can view a portion of our '50 Tips in 50 Minutes' video, which will be showing during the conference at our booth. Providers, coding staff, and PACE executives will want to stop by to take note all of these helpful hints and success strategies.

Other exciting reasons to visit our booth: 
  • Last year we had a great response to our 'button game,' and we are excited to be hosting it again this year. Be sure to check your bag for your game piece, and bring your match, to select one of our great prizes! 
  • Register to win a new Apple watch!
  • Capstone will be participating in the 'vendor bingo' game so come get our sticker to win. Our giveaway prize: a new 39-inch flat panel  HDTV!
  • We will also be offering as a limited-time, conference-only special: sign up to apply for a free, no-obligation, 10-CHART AUDIT!
(continued below)
Richard Schamp, MD
Progress Notes:
As we wind down toward October 1 and ICD-10, we have had a chance to visit and train all of our clients, as well as provide a well-received webinar series for the PACE Community.  We sincerely hope your organization is ready for the change and will weather the transition well.
Meanwhile, we continue to remind and train providers about common circumstances that lead to errors in documentation, coding and payment. CMS conducted a study that identified risk adjustment diagnoses likely to be associated with payment error, and examined the reasons these diagnoses are problematic.  The findings are not surprising, and mirror what we often discover in our audits.  Common payment errors include:
  • Neoplasms stated as 'active' when they are 'history' and vice versa.  For example, prostate and breast cancer stated as 'current' without evidence of current treatment or palliative care.  Or, cancer described and coded as 'historical' because of clinical resolution, yet treatment continues. 
  • Diabetes with linked manifestations requiring support for both components.  For example, diabetes with renal manifestations, or peripheral circulatory manifestations that are not clearly linked by acceptable language, showing a cause and effect between the diabetes and the complication.
  • Signature and credential deficiencies without proper attestation.  This is less common with electronic medical record (EMR) systems that capture credentials, but it is important to remember that an unsigned or open note is not considered to be supporting evidence for a submitted diagnosis code.
We routinely identify and highlight errors like these in audits for our clients, and strongly recommend that organizations have workflows in place to manage the audit outcomes effectively.  All providers deserve the protection and support that routine audits provide, and compliance officers deserve the reassurance.  Nearly all industry experts expect an increase in documentation and coding errors during the first few months following implementation of ICD-10.  We will be diligent to mitigate these risks.  Please let us know if you have any questions or concerns about how we can assist.   
RSVP by clicking HERE
Risk Adjustment Today:
Matt Zimmerman
Risk Adjustment Consultant

New Enrollment and Disenrollment Requirements
for Plans in CY2016
In early September CMS released the updated "CY 2016 MA Enrollment and Disenrollment Guidance" One major change this year is the transitioning of responsibility for good cause reinstatement requests directly to plans. In the HPMS memo released on 08/19/15 titled "Revisions to Good Cause Process" CMS defined the changes and requirements.  Continue Reading

In addition to all the 
excitement  at our booth and on the app, Capstone will be sponsoring the program appreciation social event 'Cocktails, Conversation, Connecting'. Please click on the link above to RSVP and mark your calendars! -We can't wait to see all of you there!

Neta Kessler
Operations Manager
Capstone Performance Systems
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