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Capstone Risk Adjustment ServicesTM

Healthcare organizations provide critical services that should be reimbursed accurately. Capstone Risk Adjustment Services helps these organizations succeed by ensuring compliance and optimizing revenue. Our experienced team of experts deliver meaningful analytics to help staff and providers understand the complexities of Medicare risk adjustment. And with training in documentation and diagnosis coding, data collection and analysis, and submission processes, your team can feel confident in optimized financial and regulatory outcomes to allow providers to focus on care delivery.

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Capstone Risk Adjustment Services offers timely, complete, and accurate data to help organizations optimize processes related to Medicare’s risk adjustment payment. We also assist programs in adapting to industry changes, including encounter data reporting and ICD-10 updates.

“Capstone has helped us achieve accurate and specific documentation through excellent on-the-ground training, provider coaching, chart reviews, condition-specific guidance—and the list could go on. They are a valued partner.”

–Drew Crenshaw, Senior Vice President, Population Health at Oak Street Health

Core risk adjustment services

With an industry-proven approach, our risk adjustment core services optimize outcomes with services that offer a strong return on investment and consistently improved risk scores. Our services include:

Chart audits

  • Accurate diagnosis coding and supporting documentation to verify compliance
  • Suspect recommendations highlighted to identify opportunities
  • Creation of redaction and submission Risk Adjustment Processing System (RAPS) files to be sent to the Centers for Medicare and Medicaid Services (CMS)
  • Monthly report reviews
  • Webinar review sessions with a registered nurse auditor to review findings and discuss trends

Data analytics

  • Analysis of risk adjustment performance based on historical and comparative data
  • Assessment of risk-score trends
  • Breakdowns of diagnosis volume, including areas of high- and low-prevalence
  • Creation of hierarchical condition category (HCC) profiles
  • Quarterly reviews of data trends with gap identification

Monitoring

  • HCC Opportunity (HOpp) reports to highlight missed opportunities
  • Routine client assessments by a client service liaison to review data flow and processes, with improvement recommendations
  • One-time evaluation of the program revenue cycle, including an analysis of 60 elements that affect revenue generation

Provider-to-provider education

  • Risk adjustment methodology and clinical documentation excellence sessions for baseline knowledge
  • Training curriculum based on audit trends to address areas of improvement
  • Education sessions for clinical staff several times throughout the year

See how our collaboration with PACE Southeast Michigan helped them enhance regulatory compliance and increase their revenue.

Concurrent coding services

The medical record is key to regulatory compliance and revenue for value-based care models, and Medicare payments are supported by careful documentation. ICD-10 coding is complex and time-consuming. Because providers may not be trained in ICD-10 coding, a great deal of time and effort can be spent searching for and verifying codes—resources that could be used for direct patient care.

Our certified and experienced coders understand the technical requirements for data collection and submission for Medicare and Medicaid. With concurrent coding services, your organization can ensure compliance to receive accurate payments and allow providers to focus on care delivery.


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