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Risk Adjustment Advisor
February 2016: Risk Adjustment for the Win
 
 
We hope that you had a wonderful holiday season, your new year is bringing success & prosperity, and your favorite Super Bowl team won.  However, if your January risk scores are making you feel more stressed than Carolina Panther's Cam Newton setting up a play, we want to help!
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Risk Adjustment Today:
Matt Zimmerman
Risk Adjustment Consultant
Complaints Tracking Module (CTM) Enhancements

On December 30th, CMS released a 2015 parting HPMS memo regarding the Complaints Tracking Module (CTM). It included an update to the Standard Operating Procedure (SOP) required for Medicare Advantage and PACE. The memo discusses numerous scenarios and issues that could arise and how to resolve them within the module. The SOP provides relevant guidance to addressing the most common issues.  Continue Reading
Richard Schamp, MD
CEO
Progress Notes: Doctor- speak vs Coder-speak
 
If I could change one thing in most Electronic Medical Record (EMR) systems, it would be to stop forcing the provider to choose a diagnosis code for each diagnosis or assessment.  This was a great disservice, done with good intentions undoubtedly, as EMR vendors tried to kill the proverbial two birds with one stone, or with one code, in this case.  Doctors and other providers are trained to write diagnostic statements that describe the conditions of the patient.  When they are forced to mold these statements into and ICD-10 code description, the chance for coding error is high, and we see them often in our chart audits. Continue Reading

Documentation Dispatch: 
ICD-10 and Documenting Diabetes

ICD-10 brought many changes to diagnosis coding, diabetes being one of them, exploding to over 200 codes. These codes are largely combination codes - meaning, if a causal relationship is stated between the type of diabetes and a complication - usually only one code is needed to describe that relationship.  In ICD-9, two codes were required to describe the complication: one for the type of diabetes and one for the complication. Continue Reading
 
Mike Brett_ MD
ABDs of Medicare: My Participant has
Hepatitis C; What do I do now?

Increasingly, PACE programs are being confronted with the issue of whether or not to treat participants who have Hepatitis C with the newer Direct Acting Antiviral Agents (DAA's). The cost of these drugs are so exorbitant that their use (among other factors) is causing PACE programs to pause and ask, "What should we do?" This month, we will discuss Hepatitis C (HVC) as a disease entity; in next month's newsletter we will discuss appropriate treatment options for HCV in the PACE setting.  Continue Reading

This year, Capstone has many exciting new plans to help not only current clients, but the entire PACE community. Watch your email for invites to special learning opportunities including conference sessions, events, and webinars. We will also be featuring special 'Case Study' newsletter articles so see how other programs have applied our knowledge to take their game to the next level.

Contact us today if you want to know how we can work with your program  one-on-one to meet your goals. We will not only get you back in the game, but have your program win with risk adjustment.

Neta Kessler 
Manager of Business Development & Marketing
Capstone Performance Systems
nkessler@cpstn.com
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