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

Risk Adjustment Advisor: May 2017


Last week, we had the pleasure of seeing many of our North Carolina clients and friends at the NC PACE Association's Annual Conference. In April, we caught-up with our Michigan clients at the PACE Association of Michigan's Business Partner Meet and Greet. These types of events provide a valuable opportunity to interact with clients and potential clients in a setting outside of the PACE centers. Sometimes we glean new insights into the challenges of providing care within the PACE model, and oftentimes we learn a few things, such as new trends in PACE. We will be at the AAHCM Annual Meeting in Chicago in July and at the NPA Annual Conference in October. If you're at either gathering, be sure to come by our booth and say hello!  

Richard Schamp, MD Chief Executive Officer 
PROGRESS NOTES:
Data Integrity Audit

We have been describing multiple aspects of risk adjustment compliance in our newsletters, along with helpful tips on documentation and coding. CMS requires PACE, Medicare Advantage and similar organizations to submit all relevant diagnosis codes at least once yearly.  A "relevant" code is one that impacts Part C or Part D payment.  Failure to submit all relevant codes is an important compliance issue.  To help our clients with the dual challenges of optimizing compliance and revenue, we introduce a new service- our RAPS Data Integrity Audit.  
 
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George Brett, MD 
Chief Medical Officer
DOCUMENTATION NOTES:
Documenting Functional Quadriplegia

It is unlikely that a clinician would overlook properly documenting a patient with neurologic quadriplegia resulting from a cervical spine injury.  However, somewhat less obvious might be functional quadriplegia that results from a patient's severe weakness. This condition is the inability to move due to disability or frailty caused by another medical condition, but not from direct physical injury or damage to the brain or spinal cord (ACP Hospitalist Coding Corner May 2012). Since documentation is focused on the severity of the underlying condition, the result of the condition - functional quadriplegia - is often missed.
CODING NOTES:
How Past Conditions Affect Current Documentation and Coding

We often see inconsistency in medical records regarding diagnoses as current or historical. Documenting "history of" when referencing a patient's past medical background is a longstanding documentation practice. Providers may intend a "present perfect" tense - a condition that started in the past and continues in the present.  However, in the world of diagnosis coding, "history of" indicates a past (or past perfect) tense; in other words, a condition that no longer exists.  


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STAFF NOTES: 
Capstone Welcomes Four New Staff Members  

Capstone Performance Systems recently welcomed four new staff members. Susan Trapuzzano, BSN, RN, CPC, CRC, is Capstone's newest risk adjustment and coding specialist. Susan has a BSN from Waynesburg University and diploma from Jameson School of Nursing. She was a field reviewer for Inovalon and served as a nuclear cardiology nurse for the University of Pittsburgh Medical Center. Risk adjustment coder Kathy Lynn, CPC, RHIT, was an instructor and the program coordinator for the Billing and Coding program at the Career Training Academy. She previously worked as a medical coder for Orion Corporation and for a private practice. Amanda Piern CPC-A, risk adjustment coder, earned her CPC-A certification from AAPC in the fall. She joins Capstone from Jabil Circuit, Inc., where she was an entity management support specialist. Data engineer Melissa Wiel-Nilson studied data science and predictive analytics at the College of Charleston in South Carolina. Her prior experience includes positions as lead software data scientist for Causam Energy, Inc., and software data scientist for Brain Power Software.
WEBINAR: 
Opioids and PACE

A recent OIG report outlines  concerns about the high proportion of Part D beneficiaries receiving prescription opioids. CareKinesis will host a webinar this month to discuss opioids and PACE.
 
Opioids: Clinical Perspectives for PACE
Wednesday, May 24 at 3 pm (ET)
Presenters:   David A. Wilner, MD, Senior Medical Consultant,  Capstone Performance Systems, and  Darria Zangari, PharmD,BCGP, BCPS, Clinical Pharmacy Liaison, CareKinesis.  Register here .

Clinical Documentation Excellence (CDE) Bulletin 

At the urging of our clients, Capstone is pleased to introduce the CDE, a monthly e-bulletin with topics relevant to Primary Care Providers. Each month, the CDE will focus on a topic that is timely or requested by our clients. Information will typically include clinical background, diagnosis tips, documentation requirements and ICD-10 coding guidance. From time to time, we'll digress to make sure that providers are in the know regarding issues that impact compliance. The format is intended to be a quick read for busy providers, with emphasis on key words and bottom-line actions or conclusions.


Vol 1 Issue 2: Documenting and Coding Nephropathy and Chronic Kidney Disease

Upcoming Conferences

Capstone Performance Systems will be sponsoring and/or 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 booth if you are attending these events! If you would like to arrange a private meeting to discuss our services and how we can help your organization ensure compliance and increase revenues, email info@cpstn.com

Capstone is Hiring!

Capstone Performance Systems is seeking to fill the position of software engineer. The software engineer position can be based in Moorestown, NJ, or Mt. Pleasant, SC, however a remote arrangement is possible. Details and application information for this and other Tabula Rasa HealthCare positions can be found on TRHC's webpage. TRHC is the parent company of Capstone Performance Systems.

For more information on our services and how we can assist your organization, email info@cpstn.com or visit CapstonePerformanceSystems.com.


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