Stay Connected:    View our profile on LinkedIn    Like us on Facebook
Risk Adjustment Advisor
Issue 8: Showing a Little Heart

We hope you had a great Valentines Day. The Capstone team would like to express our sincere gratitude to all of our client staff who helped us in successfully completing our Annual Service-Coordination Calls. We received a lot of great feedback and will continue to reach out over the next couple months to follow up on the items discussed. We hope that you found them to be just as beneficial. Please don't hesitate to contact us anytime regarding anything that was discussed or for any other needs you may have.
(cont'd below)
Risk Adjustment Today:
Importance of Monitoring RAPS Data

As you know the Mid-Year sweep of RAPS data is hastily approaching. The upcoming deadline is Friday, 03/06/15. This deadline pertains to RAPS data from calendar year 2014, which is the basis of payment in calendar year 2015. After the deadline CMS will recalculate current 2015 payments based on any new information received. With this deadline looming, now is a great time to ensure all of your ICD-9 code data has been submitted and accepted by CMS.


Taking steps now to ensure the validity of your RAPS data is a top priority. Monitoring all RAPS data for accuracy and completeness will eliminate any headaches down the road regarding missing or incorrect data. Also, an effective monitoring plan will ensure accurate Medicare payment in 2015 and reduce time spent waiting on the final reconciliation in 2016.


If your Plan utilizes a 3rd party submitter or if you submit the RAPS data on your own it's important to remember that the process of monitoring and auditing the RAPS data is ultimately the Plans responsibility. Below are a few questions to ask about the effectiveness of your monitoring and auditing plan. Continue Reading


February 2015
Progress Notes:


Some believe they got lucky when the ICD-10 implementation deadline was extended to 2015 because they had procrastinated on learning it.  All indications are that the deadline will not be extended a third time, so further hoping is probably not a good strategy.  To make the transition manageable in your program we recommend scheduling some time every month to work on it, starting as soon as possible.


While coding guidelines remain largely the same, ICD-10 is a very different coding system from ICD-9 for most clinicians and coders. There's going to be a pretty steep learning curve.  Here are some recommendations to keep in mind. Continue Reading

The ABD's of Medicare:
Tips for Coding Heart Failure

Sometimes, we providers use terms that are very specific and covey a tremendous amount of meaning. Two of those terms are "Ischemic Cardiomyopathy" and "Hypertensive Cardiomyopathy." When I hear those terms I get a sense that there is dysfunction of the heart - "Heart Failure" - caused by coronary artery disease or hypertension.

If you use those terms, thinking that you have documented a specific type of Heart Failure and that you are capturing its associated HCC 85, think again. Continue Reading


On Target:  AltaMed Senior BuenaCare


 "AltaMed is certainly one of the largest PACE programs in the United States; however, we are impressed with the attention to detail they give to their entire health plan management system. They address  audit reports, and fastidiously dissect the Zero HCC Reports and HOpp Reports that Capstone provides. Review of the most popular HCC's, shows that AltaMed has had a steady improvement in detecting, documenting and coding these common diagnoses. As a result their risk score has shown progressive improvement every year. The audit reports suggest that though there is  increased diagnostic data is based on complete and accurate documentation." -Dr George Brett, Chief Medical Officer


 Great Job, Altamed Senior BuenaCare!

Documentation Dispatch: 
Coding for Osteoarthritis

Osteoporosis is a disease of the bones common to the population we treat. Osteoporosis can affect both men and women and woman can lose up to 20% of their bone mass in the years after menopause.  

There are two categories of Osteoporosis: primary and secondary. Primary osteoporosis includes postmenopausal, senile and idiopathic. Secondary osteoporosis is caused by various medical conditions including chronic kidney disease, rheumatoid arthritis and hyperthyroidism.

Coding for osteoporosis is not difficult if the documentation indicates which type of osteoporosis is present. Continue reading.


Since our last newsletter, the Capstone team took had an opportunity to thaw in beautiful New Orleans, Louisiana for our semi-annual face to face company meeting. This trip was arranged to also allow us to participate in a run/walk charity event for Achilles International. (You can see pictures of the team post-event on our Facebook page.)This foundation helps those with disabilities (ie wounded veterans) to participate in athletic events by providing training and support. Their mission is 'to bring hope, inspiration, and the joys of achievement to people with disabilities.'  We know you can understand and appreciate this objective as you provide compassionate services to your participants, and you can count on us to always strive to find new ways to support you.



Best Regards,   

Neta Kessler MS
Operations Manager
Capstone Performance Systems

Next Month:  'You Don't Need Luck'
Capstone Performance Systems |