It seems Spring is finally here, and that means conference season! It was a pleasure to meet some of you at the recent National PACE Association's Spring Policy Forum in Washington, DC. For clients and friends in Michigan and North Carolina, you may have had the opportunity to meet my colleagues at events in your state. These meetings are so valuable to us as they provide an opportunity to meet you face-to-face and to hear about the trends and issues affecting you and your ability to continue to provide high-quality care to those you serve. We are proud to support you in your efforts!
There is much news to share about our industry, our company, and our CareVention HealthCare (CVHC) partners. Read on to learn more, and of course feel free to contact us at
if we can be of assistance to you in some way.
Executive Vice President
Tabula Rasa HealthCare
Risk Adjustment Advisor: May 2019
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RISK ADJUSTMENT TODAY:
CMS Announces Changes to HCC Payment Model for 2020
By George H. Brett, MD
Chief Medical Officer &
Senior VP, Consulting Services
On April 1, the Centers for Medicare & Medicaid Services (CMS) released the Final Announcement outlining changes to the HCC Payment model for Medicare Advantage Plans and PACE Programs for Payment Year 2020. The HCC model used to calculate risk scores for PACE will change from the version used since 2012 (Version 21) to the 2017 model known as Version 22.
Introducing the Medicare Revenue
Cycle Report by Capstone -- Ensure
your plan is receiving the payments
Each month, PACE plans receive a Medicare Member Report (MMR) from CMS. The information is critical to a plan's bottom line, but accessing the report is difficult and the data contained is voluminous. The new Medicare Revenue Cycle Report by
Capstone Performance Systems provides this information in a convenient, easy-to-understand format that highlights key indicators that can impact your program.
Documenting and Coding for Past Conditions
By Wendy L. Myers, CRN-C
Risk Adjustment & Coding Specialist
While providers and coders work together in the health-care field, there are notable differences between the clinical and the coding worlds. Providers are not always aware of every coding guideline, and this can sometimes result in documentation that is not as specific as needed for coding purposes. This lack of specificity can cause confusion at times. An example of this is documenting current and historical conditions in the medical record. It is a longstanding practice for providers to use the term 'History of' when referring to a patient's past conditions, whether the condition is currently present or historical in nature.
Dr. David Wensel of Midland Care
Named First Recipient of Richard O. Schamp, MD, Award
David Wensel, DO, Chief Medical Officer of Midland Care in Topeka, Kansas, was named the first recipient of the Richard O. Schamp, MD, Award. The Award was presented by David Wilner, MD, Capstone's Senior Medical Consultant, at the CareVention HealthCare dinner during the NPA Annual Conference in Portland, Oregon, last fall.
As Chief Medical Officer for Midland Care, Dr. Wensel has been instrumental in the development of the PACE program at Midland. After joining Midland in 2010, he helped to start the palliative medicine consultation service at St. Francis Medical Center in Topeka, and one of the first outpatient palliative medicine clinics in a community oncology practice at Cotton O'Neal Cancer Center.
Read the text of Dr. Schamp's remarks that evening here.
PEAK Health Plan Management Update:
Focusing on the Client Experience
In May 2018, Capstone Performance Systems acquired Peak PACE Solutions, which became PEAK Health Plan Management, a service of Capstone. Over the past year, Capstone-PEAK leaders have worked to enhance the PEAK client experience. Here are just a few of the many changes that have been implemented to date:
The PEAK team looks forward to continued performance improvement. They remain committed to working proactively with clients to enhance efficiency and improve satisfaction.
- Enhanced talent acquisition, including the size of the provider call center team
- Instituted a new, standing agenda for monthly client calls that enables the PEAK team to better evaluate a client's internal workflow along with PEAK's workflow
- Instituted more departmental/team 'huddles' focusing on communication, planning, work allocation, and clients' needs to enhance satisfaction
- Introduced efficiency into the invoice process
- Improved significantly the claims backlog, with a continuing focus on improving this metric
- Implemented automated inpatient pricing; outpatient hospital pricing is being addressed now
PEAK Client Service Enhancement:
New Precluded Provider Service
On January 1, 2019, CMS published a "Precluded Providers" list of providers and prescribers who are barred from receiving payment for services, health care items, or Part D drugs furnished or prescribed to Medicare beneficiaries. Effective April 1, 2019, PACE organizations must reject or deny payments for services, healthcare items, and Part D drugs furnished or prescribed by providers (also called "excluded" providers) and prescribers on the preclusion list.
PEAK Health Plan Management
is introducing a new service, which will be provided
at no additional cost
to clients. Each month, PEAK will compare a client's Provider list to CMS' list of excluded providers and notify the client of any matches. The service is an additional measure PEAK takes to ensure that clients remain compliant with regulations. For information, email
Mark your calendar for upcoming conferences and events!
Capstone Performance Systems, its divisions PEAK Health Plan Management and the PACE Technical Assistance Center (TAC), along with our CareVention HealthCare sister companies (CareKinesis, Cognify, eClusive, and Mediture), will be participating in several conferences and meetings in the upcoming months. We hope to see you soon!
June 7-9: NPA Summer Conference (Little Rock, AR) - Capstone and CareVention company staffs attending
June 20-21: CareVention HealthCare Advisory Summit
(Philadelphia, PA, and Moorestown, NJ) Meeting of CEOs/Executive Directors and CFOs from CareVention client companies (see CareVention News, below)
June 25: CalPACE PassPort
(Sacramento, CA) - CareKinesis exhibiting
August 28-29: CalPACE Member Dinner
(co-sponsored by PEAK Health Plan Management and Cognify) and Meet & Greet (Sacramento, CA) Capstone | Peak, TAC and CareVention companies exhibiting
October 13-16: National PACE Association Annual Conference
(New Orleans, LA) - Capstone | PEAK, TAC and CareVention companies exhibiting
October 27-30: LeadingAge Annual Meeting & Expo
(San Diego, CA) - CareVention exhibiting *tentative
November 6-7: CalPACE Member Dinner
(Capstone and CareKinesis co-sponsoring) and
Meet & Greet
(Sacramento) Capstone | Peak, TAC and CareVention companies exhibiting
November 11-13: National Association of Medicaid Directors (Washington, DC) Capstone TAC exhibiting
Capstone Performance Systems, a Tabula Rasa HealthCare (TRHC) company, and its Peak Health Plan Management and PACE Technical Assistance Center (TAC) are part of TRHC's CareVention HealthCare Division. CareVention HealthCare also includes TRHC's other PACE-focused subsidiaries: CareKinesis, Cognify, eClusive, and Mediture.
CareVention HealthCare Advisory Summit
CEOs, Executive Directors, and CFOs of CareVention client organizations, mark your calendars for the inaugural
CareVention HealthCare Advisory Summit
June 20-21 in Philadelphia, Pennsylvania, and Moorestown, New Jersey. The gathering, exclusively for leaders of PACE organizations served by CareVention companies, will focus on forthcoming advanced technology, analytics, personalized medicine, and more. Continuing our theme of "Working Together for PACE Success," the Summit will offer networking opportunities and peer interaction on various topics. Contact
TruChart User Group
Mediture TruChart users are invited to a TruChart User Group, an education and networking event on
August 8 and 9
at TRHC's administrative offices outside of Philadelphia. The goal of the conference is to equip TruChart users with new ideas on using technology to support their organizations. The agenda will include sessions led by both Mediture staff and clients. TruChart System Administrators, Executive Directors, Medical Directors, and other key team members who utilize TruChart will benefit from this event. Details and registration are available
. Questions? Contact Tara Florek at
Are you a TruChart user interested in presenting at this event? Please contact Tara Florek by June 1!
City Sips & Capital Conversations at the NPA Spring Policy Forum
Thank you for joining Capstone | Peak, TAC and the other CareVention companies at our City Sips & Capital Conversations event!
CareVention HealthCare (CVHC) leadership shared important technology and services updates, as well as plans for future offerings. Speakers included TRHC executives Calvin H. Knowlton, BScPharm, MDiv, PhD, CEO, Chairman, and Founder; Richard O. Schamp, MD, Chief Medical Officer; Kim Browning, Executive Vice President; and Mark Friedman, Chief Technology Officer of Cognify-Mediture. We hope you enjoy these pictures from this special evening!
Clinical Documentation Excellence (CDE) Bulletin
Did you know Capstone Performance Systems offers Health Plan Management and PACE Operational and Technical (TAC) Services?
Capstone Performance Systems
now offers a comprehensive menu of services to PACE organizations, from the exploratory/start-up stage through ongoing operations.
Peak Health Plan Management
division provides services that optimize an organization's financial management and fulfill regulatory requirements for health plans. Services include enrollment management, encounter data processing and submission, claims adjudication, and Medicare Part D submissions and reporting.
PACE Technical Assistance Center
(TAC) team has decades of combined PACE-specific experience. The team's provides services to help organizations in all phases of PACE-related growth, from exploring PACE, through developing and improving PACE operations.
© Capstone Performance Systems 2019. All rights reserved.
Kim Browning, Publisher/Executive Editor
Carla Davenport, MBA, MS, Editor