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Capstone Performance Systems offers comprehensive provider-to-provider/staff training, auditing and data analysis for focused strategies and improved compliance.
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Risk Adjustment Advisor: January - February 2018
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Richard Schamp, MD Chief Executive Officer
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The new year is well underway, and it's shaping up to be a busy one. CMS' initiative to transition from Health Insurance Claim Number (HICN) to Medicare Beneficiary Identifier (MBI) moves forward, with PACE plans receiving an initial Crosswalk file in March. Read about the next steps in the transition below.
Capstone Performance Systems continues to grow. In addition to adding two staff members, we've also moved to a new office in St. Louis. This location will serve as our home base and house members of our new Planning, Management and Development team. Our goal is smart growth that allows us to continue to provide the exemplary service for which Capstone is known.
Richard Schamp, MD
Chief Executive Officer
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PROGRESS NOTES:
Clinical Documentation: A New Competency for Providers?
By Richard Schamp, MD
CEO
Multiple risk adjustment models are active across the US healthcare landscape. If you are reading this, you probably already live in a risk-adjusted payment world. For example, the Centers for Medicare & Medicaid Services (CMS) uses a risk-adjusted model that pays PACE and Medicare Advantage plans based on a person's demographics and age, with additional payments made per qualifying diagnosis. States may establish a risk adjustment program using different methodologies for their Medicaid capitation payments. In addition, states may propose alternate risk adjustment methodologies for commercial insurance.
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Documentation Dispatch:
Diabetes and ICD-10
By Lynn Diorio, CCS-P, CRC
Risk Adjustment Coder
Coding for diabetes can be a daunting process. Clear and concise documentation
by the provider is key in helping to ensure that the condition is captured appropriately. There are five major categories that diabetes can fall into in ICD 10: Type 1 (E10); Type 2 (E11); Diabetes due to underlying condition (E08); Drug or chemical induced (E09); and other specified (E13).
Diabetes due to an underlying condition (E08) is never used as a primary diagnosis and is reserved for individuals who develop DM as the result of an underlying condition such as pancreatitis, malnutrition, or malignancy. It is important that the provider documents the condition that caused the DM to develop. If the conditions are not clearly linked, a query by the coder to determine the underlying cause will be necessary.
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RISK ADJUSTMENT TODAY:
MARx HICN to MBI Crosswalk file - Coming in March
By Jennifer Zimmerman
Client Success Specialist
The Health Insurance Claim Number (HICN) to Medicare Beneficiary Identifier (MBI) CMS initiative will take another step forward in 2018. The transition in the MARx User Interface will begin in April, and, in preparation, a MARx HICN to MBI Crosswalk File will be generated for each Plan.
In March, PACE Plans will receive an "initial" HICN to MBI Crosswalk file which will include current membership back to 2006. A monthly file will be sent thereafter to capture any new enrollment changes.
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Capstone Welcomes New Staff Members
Capstone Performance Systems recently welcomed two new staff members.
Betty Montgrain is Capstone's new manager of Planning, Management and Development. In this role, Betty will oversee the administrative operations of the new Capstone office in St. Louis, Missouri. Betty comes to Capstone with more than 30 years of experience managing physician practices, including 3 years as a multi-site practice manager for St. Anthony's Physician Organization in St. Louis. Prior to that, she was the medical practice office manager for Westglen Family Physicians in Ellisville. Betty has a certificate in supervision from the University of Missouri.
Rachel Silansky, CPC,
is Capstone's newest risk adjustment coder. Rachel previously worked as a remote HCC coder for The CSI Company. She was also a coder for the Department of Trauma at St. Francis Medical Group and a coding/reimbursement specialist for University Physicians, both in Connecticut.
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Spring 2018 Conferences
Capston
e Performance Systems
will be
participating in two conferences n
ext month. We look forward to seeing our Michigan clients and friends on
March 9
at the
PACE Association of Michigan's Meet & Greet
in Lansing. If you are heading to the
National PACE Association's Spring Policy Forum on March 19 and 20
in Washington, DC, Capstone will be exhibiting at Table 3. To arrange a private meeting with a Capstone representative at either event, please contact us at
[email protected]
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CEO Richard Schamp, MD, and Betty Montgrain, manager of Planning, Management, and Development, in Capstone's new St. Louis office. |
We've moved!
After several years as a remote company,
Capstone Performance Systems has opened a new office in St. Louis, Missouri. Several staff members will be based at that location, including CEO Richard Schamp, MD, and John Stolze, senior vice president of Planning, Management and Development.
Our new address:
9920 Watson Road, Suite 109
St. Louis, MO 63126
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Clinical Documentation Excellence (CDE) Bulletin
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© Capstone Performance Systems 2017. All rights reserved.
Richard Schamp, MD, Publisher/Executive Editor
Carla Davenport, MBA, MS, Editor
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PACE industry
information, and more!
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