Happy Holidays from the Capstone Performance Systems family!

Risk Adjustment Advisor: December 2016
Richard Schamp, MD CEO
Medical Necessity and Internal Auditing Compliance
Several times in 2016 my comments in this column have emphasized elements related to corporate compliance with regulations and rules governing documentation and coding.  As 2016 comes to a close, I wish to share two key messages from a recent compliance and auditing conference.

Listening to presentations from several prominent healthcare lawyers, I was reminded of the priority (which we have mentioned repeatedly here) for all healthcare organizations, especially health plans, to have robust internal auditing and monitoring processes and appropriate policies and procedures to support the audit results. Our observation among PACE organizations is that the dominant priority is service delivery and patient care, while the administrative infrastructure to support compliance and internal auditing is typically limited. We can assist plans to develop their processes and also provide outside auditing related to documentation and coding.

Ulcers: Pressure and Non-Pressure (Chronic)

When documenting ulcers, it is important to clarify whether the ulcer is a pressure or non-pressure ulcer.  When a provider only documents the stage of the ulcer, such as "stage 2 ulcer, left heel", it does not provide enough information for the coder to determine the proper code assignment. Once the provider makes the determination of chronic non-pressure or pressure ulcer, it should be documented as such.  The documentation for these two types of ulcers is very similar.

Capstone Welcomes Four New Staff Members

Capstone Performance Systems recently welcomed four new employees, including two Risk Adjustment Coders.  Marina "Nina" Gonzalez, CPC , joins Capstone from Excela Health Organization in Pennsylvania. At Excela, she worked primarily with orthopedic and neurological coding and also did gastrointestinal and ENT coding. A Certified Professional Coder (CPC), Nina has an ASB, with a focus on advanced medical coding, and is working toward attaining Certified Risk Adjustment Coder (CRC) certification through the AAPC. 

For our other new Risk Adjustment Coder  Becky Priest, CPC-A, CPB, coding is actually a second career. Becky previously worked in finance/accounting, including more than 25 years in the construction and auto dealership industries. A position as Finance Manager at the CentraCare PACE program in Battle Creek, Michigan, piqued her interest in the risk process and coding. She subsequently earned certifications in coding and billing, and joined Capstone in November.

Nurse Coder Deborah Ploschnitznig, RN, RN-C, most recently served as Director of Nursing at Rochester Manor and Villa, a convalescent and long-term care facility in Rochester, Pennsylvania, where she worked closely with the health and facility management teams. In addition to topnotch patient care and management skills, Deborah brings a wide-ranging knowledge of administrative requirements for proper documentation and experience in reviewing documentation to ensure accuracy and completeness.

Capstone's new Client Success Specialist, Jennifer Zimmerman, has extensive experience in client relations. A RE/MAX realtor for the past 14 years, she is a 6-year recipient of the 5 Star Professional Award for quality customer service. Based on consumer nominations, the award is presented to the top 7% of realtors in the Denver area. Prior to entering the real estate field, Jennifer worked in the telecom industry as a project and product manager.

Our new staff members are looking forward to meeting you. We are sure you will enjoy working with them, and we hope you will have a chance to interact with them soon.
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For more information on our services or how we can assist your organization, visit cpstn.com, email info@cpstn.com, or call (720) 279-4510.