Risk Adjustment Advisor
Issue 5: Giving Our Thanks
Even though we returned home from the NPA Conference to freezing temperatures we are really feeling the warmth this season! It was exciting to see so many long-time friends and meet so many new faces. It was also wonderful to hear so many programs tell us how happy they are because of what  we have been able to help them accomplish this year. So, in the spirit of this appreciation, we have decided that before we look forward to the next year, we are going to focus this issue on thanking our fabulous clients.
(cont'd below)
Risk Adjustment Today:

Hello Everyone,

In reviewing HPMS memos over the past few months there is one memo that stands out and contains an important change. The HPMS memo issued on 09/10/14 called "Deadline for Submitting RAPS Data for Use in Risk Score Calculation Runs for Payment Years 2014, 2015, and 2016" defines an earlier date for the upcoming RAPS sweep. The major change defined by CMS is to the 2015 Mid-Year deadline for submission of RAPS data. In prior years that deadline was in early March every year. Now the deadline has been moved up to Friday, 02/06/15, about a month earlier than previous years.

This memo sets the new deadlines for submitting RAPS data into 2016. Take a moment to familiarize yourself with these new dates. Submitting complete RAPS data before any sweep deadlines will ensure accurate and complete payments from CMS. This memo is also posted on the CSSC Operations website under 'Risk Adjustment Processing Systems/HPMS Memos'.

November 2014


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Progress Notes:
Thinking ahead a short time to Thanksgiving holiday, we recognize the blessings that come our way to enjoy.  I want to highlight some of the Capstone blessings in my column this month.


Capstone staff enjoyed the opportunities to meet many of our clients in person at San Diego during the NPA annual conference.  The conference had a lot of positive energy and is always a good time for networking.  This was our first year as an independent sponsor, contributing to the overall success of the conference in multiple ways.  Our Capstone Button contest was a big hit and dozens of attendees found their match and made new friends.  We had a lot of good buzz around that, so we are looking forward to expanding the button contest next year.


We want to acknowledge Neta Kessler for designing and implementing our new booth and marketing materials that showcased our new logo well at the conference.  We thanked NPA for the better design of the vendor exhibitor hall this year, with tables and chairs for attendees to enjoy refreshments.


Besides the conference, we are thankful for both new and existing clients that we have the privilege of serving this year, enumerated below.  We learn from all of them and as we see needs, we adapt and develop services to help meet those needs.  We can only do that because of the immense talent that resides in our staff and their selfless attitude of service.  If you've met any of them, you know exactly what I mean, and I am grateful for each of them and what they bring.


We also give thanks for the challenges that lie ahead.  With ICD-10 and Encounter Data Reporting and compliance issues looming in 2015, there's plenty of work to be done.  We'll talk more of that in next month's issue.


Thankfully yours,

Richard O. Schamp MD



In lieu of our usual 'On Target' section, that singles out one program who has done an exceptional job, we would like to take this opportunity share our sincerest appreciation for ALL of our retainer clients:


As well as clients served through their agreement with Peak PACE Solutions:


Albright PACE

Inspira Health Network LIFE

Kissito PACE

LIFE at Lourdes

LIFE Lutheran Services

LIFE St Mary 

PACE of the Southern Piedmont

PACE of the Triad

Palm Beach PACE

St Joseph of the Pines

Total LIFE Healthcare 

Thank you for allowing us to continue to serve your programs. We can't wait to see how far you go in 2015!
Documentation Dispatch: 
Documenting Dementia

Dementia can be the result of one or more pathologies. It is not uncommon for dementia to present in a PACE setting with no clear cause or associated neuropathology. However, if the cause or neuropathology is known, it is important that it be documented so the proper code(s) may be assigned. Whether or not the neuropathology is known, it is just as important to document the type of dementia: pre-senile (onset before age 60), senile (after age 60) or vascular (following typical clinical pattern).  

For example, Vascular Dementia due to cerebral atherosclerosis would require an additional code for the cerebral atherosclerosis. If vascular dementia is a result of cerebral atherosclerosis, this must be documented and thus two codes would be assigned: 290.40 and 437.0. Senile dementia due to Alzheimer's Disease would be coded as 290.0 and 331.0.


We also want to express our gratitude for our new parent organization Tabula Rasa Healthcare, and sister company CareKinesis. It has been an honor to team up with companies that care so much about advancing the PACE model, as well as for their clients and employees.


Not only is it time to be thankful, but it is also the time of year to plan on our Annual Service Coordination call.  Be on the look out for a scheduling email within the next week or two. We look forward to speaking with you about how we can make our services even better for your programs. Your prompt response to this coordination effort is greatly appreciated.


From all of us at Capstone: Have a blessed and happy Thanksgiving! 


Best Regards,   

Neta Kessler MS
Operations Manager
Capstone Performance Systems

Next Month: 'Looking Forward to 2015'
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