Capstone Performance Systems offers services that improve documentation, support compliance, and optimize revenues for organizations that manage or deliver healthcare.

Risk Adjustment Advisor: July 2017
Richard Schamp, MD Chief Executive Officer

Summer is well along, and while this signals the time to take a relaxing vacation, our client work at  Capstone Performance Systems continues unabated. Additionally, we are busy planning for the annual meetings of the National PACE Association (NPA) and the American Academy of Home Care Medicine (AAHCM). We hope to see you at one of these meetings in October. In the meantime, please read on for some useful information!

Richard Schamp, MD
Chief Executive Officer 

CMS Final Reconciliation Delayed

PACE organizations are accustomed to receiving final reconciliation of the prior year's Part C and Part D payments in July. This reconciliation is reflected in the Monthly Membership Report (MMR) and typically includes a positive true-up payment, especially if retrospective reviews were done in timely fashion.  However, this year the PY2016 reconciliation is delayed until October, as CMS communicated during their April CMS Risk Adjustment EDS & RAPS User Group presentation. The delay is due to the Encounter Data reporting extension for Medicare Advantage Organizations, but impacts PACE as well.

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Reminder: CMS has indicated the next  RAPS and EDS submission deadline is Friday, September 1, 2017.  This deadline applies to dates of service from July 1, 2016 through June 30, 2017. This data sweep will inform the initial CMS HCC model run for Payment Year 2018, impacting payments for January to July 2018.  We urge PACE clients to provide all encounter and RAPS diagnosis data to CMS or to their Third Party Submitter early enough in August to allow for processing and error corrections.

CODING NOTES: Tips for Coding Degenerative Disc Disease (DDD) in ICD-10.

Degenerative disc disease (DDD) describes the symptoms of pain and possibly radiating weakness or numbness stemming from a degenerated disc in the spine. Simply put, DDD occurs when an intervertebral disc loses its integrity, eventually causing pain. The condition is most often caused by age-related deterioration of the spine. The discs in the spine support the vertebrae, allowing the vertebrae to move and hinge without colliding with each other. Eventually, the loss of elasticity in the outer layer of the disc coupled with chronic pressure on the disc from the surrounding vertebrae may cause disc damage, including herniated discs, bulging discs, disc protrusions, spondylolisthesis, and spinal stenosis. However, identifying the damage is not sufficient for a coder to code to the highest level of specificity. The provider must document clearly and concisely the diagnosis of DDD and the location on the spine for the diagnosis to be properly coded.

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Capstone Welcomes Two New Staff Members  

Capstone Performance Systems has added two risk adjustment coders to its team.
Rebekah Lester, CPC, previously worked as a critical care coder for Physician Technologies in Millvale, PA. She earned her medical coding diploma from the Bidwell Training Center.  Kayla Kappeler, CBCS, CCMA , served as a team lead documentation review specialist for Medbill LLC in Plum, PA. She attended the Institute of Medical Careers in Penn Hills, PA. 

Clinical Documentation Excellence (CDE) Bulletin 

Capstone Performance System's Clinical Documentation Excellence (CDE) Bulletin, is a monthly e-bulletin with topics relevant to Primary Care Providers. Information typically includes clinical background, diagnosis tips, documentation requirements and ICD-10 coding guidance. Each month, the   CDE Bulletin focuses on 
a topic that is timely or requested by our clients. Recent issues explored Documentation and Coding for Skin Ulcers and Diagnosing, Documenting & Coding COPD. To suggest a topic, contact Richard Schamp, MD. Past issues are available on .

Upcoming Conferences

Capstone Performance Systems will be exhibiting at several conferences and events this year:

October 12 - 14: American Academy of Home Care Medicine (AAHCM) 
Annual Meeting (Rosemont, IL)
October 15 - 18: National PACE Association Annual Meeting (Boston, MA)

Be sure to visit us at our exhibit booth if you are attending these events! If you would like to arrange a private meeting to discuss how we can help your organization ensure compliance and optimize revenues, email

For more information on our services and how we can assist your organization, email or visit

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PACE industry  information, and more!

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