Risk Adjustment Advisor
Issue 2: Our New Image
This month we are featuring our new logo. Capstone embraces not only innovation in our services, but evolution in our business. This evolution has occurred as we have grown to service more clients and provide newer, and more advanced services, to meet a variety of needs. Changing our logo is one step we have taken to give our clients, and future clients, a better understanding of who we are and what we strive to achieve.

With this logo, we wanted to show how we have a fresh and modern approach combined with reliable knowledge from a long-trusted reputation in the Pace community. The C stands as an incomplete circle, reflecting the gaps (needs) of our clients.  Capstone staff and services occupy the dot in the 'C', partnering with our clients to achieve wholeness by closing certain gaps with care and in forming the complete 'O'. The overall message is that Capstone identifies the 'missing piece' client's need to make their processes whole.  

We hope this new image will serve as a reminder of what we are best at: helping clients in 'Realizing True Potential.'

(cont'd below)
Risk Adjustment Today:

The Importance of Updated Policy for each Part D Audit Element

All PACE plans will receive some sort of Part D audit. It's going to be now or in the future. That's why it's always a good time to review your current Part D policy to ensure all audit elements are up to date. Routine Part D policy analysis at your plan is paramount to achieving a successful audit. Development of Part D policy and a solid Part D work plan will allow for success at each CMS audit. If your Plan needs help with this important often overlooked process please call us for a comprehensive Part D Consultation.


August 18, 2014


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Progress Notes:
Using your Model Output Report


Each month, CMS provides a report that indicates which demographic (age, gender, entitlements for Medicaid and disability) and disease (HCCs and disease interactions) factors are used in calculating the risk score for your plan enrollees.  This report is called the Model Output Report, or MOR.  PACE plans receive MORs for both Part C (CMS-HCC) and Part D (RxHCC) risk adjustment models.  The MOR is  available in both data (HCCMODD) and report (HCCMODR) formats as described in the Plan Communications User Guide (PCUG). 


The MOR reflects currently enrolled participants each month (usually a one-month lag following enrollment).  The HCCs in the MOR are updated each time the CMS model is run.  The Initial model run is typically for Jan-Jun payment months.  The Mid-year model run covers Jul-Dec payment months and the Final MOR is run after the final submission deadline (Jan 31) to show the HCC indicators used to determine the final risk scores for the previous payment year, which will be used in the final payment reconciliation.


The MOR is useful for clinicians to review, especially for new PACE enrollees.  This is because the MOR reflects diagnosis categories that were triggered in the year prior to the payment year and can inform the clinical staff to possible diagnoses that have been previously submitted for a participant.  This information can help to fill out the clinical scenario or may prompt additional investigation into the medical history.  Quite often, however, we see conditions on the MOR that appear to be no longer applicable (or perhaps never were), so caution must be used to verify all diagnoses appropriately before documenting them again.


Please contact us if you want to learn more.

Immanuel Pathways started in 2012 and is now serving over 100 participants.
  On Target:  Immanuel Pathways, IA

  "The staff at Immanuel Pathways is consistently         
  working on improving internal processes and overall    
  knowledge of the PACE model of care. 

  Recently, I helped the staff at Immanuel Pathways   
  undertake a complete review of their existing Medicare
  Part D work plan. The updates to this process are of
  tremendous value to the organization and have helped
  identify and close any gaps that were present. Through
  this development and review process they have
  updated their internal monitoring and auditing tools to
  provide consistent feedback in an effort to identify any anomalies or inconsistencies at their Part D programs. These efforts are already paying dividends because they are able to identify and correct any issues before they become a systemic problem. This proactive approach to both managing and monitoring their Part D programs will provide confidence and security. Thanks to their dedicated staff and a willingness to learn and grow this plan will be successful for years to come." -M Zimmerman, Risk Adjustment Consultant

Keep up the good work, Immanuel Pathways!  
We are Growing!
Special Welcome to the Newest Members of the 'Capstone Family of Providers':
Suncoast PACE

Brandman Centers for SeniorCare

Cherokee PACE
Documentation Dispatch:
Diagnosing and Documenting for Chronic Kidney Disease.  
It is important to screen any participant with co-morbidities of diabetes and hypertension for chronic kidney disease. CKD is more prevalent in populations with those co-morbidities. CKD stage 3 is defined as a GFR <60 for 3 months or more. CKD stages 1 and 2 require other evidence of renal disease in order to properly diagnose and support. This includes hydronephrosis, proteinuria, polycystic kidney...etc.   Proper assessment and management of this condition is essential in the elderly population.
Product Spotlight: Retrospective Chart Review


Now is the time to consider a Retrospective Chart Review! Capstone is pleased to announce this new service, designed to identify missed opportunities for diagnosis documentation and coding, to further support the Risk Adjustment model. Encounters from the previous year will be reviewed by our experienced coders and chart auditors for any and all diagnoses that are eligible to be submitted. Don't leave you money on the table. We have helped clients recover hundreds of thousands of dollars in lost revenue, and we only charge a setup fee and a small percentage of what we recover! Let us assist you in putting money back in your plan's pocket.  


Contact us today for more information and schedule a free evaluation to determine if a Retrospective Chart Review is right for your program.  

Our new logo is currently featured on the NPA website, announcing our exciting sponsorship this fall at the NPA conference in beautiful San Diego. 


Planning to attend? Capstone, along with CareKinesis, will be hosting a PACE appreciation event the evening of Sunday, October 26th. Please save date and watch your email for RSVP details.
Best Regards,   

Neta Kessler MS
Operations Manager
Capstone Performance Systems

Next Month: NPA Conference Excitement!
Capstone Performance Systems |

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