Presented by Betsy Canino, MSN, CRNP Sherry Simpson, MSN, ANP-BC Richard Schamp, MD

56 Pages·2016·2.33 MB·English

by  Richard Schamp

50 Tips in 50
Minutes
Presented by
Betsy Canino, MSN, CRNP
Sherry Simpson, MSN, ANP-BC
Richard Schamp, MD
Overview
of RAPS
Process
Build Risk
Adjustment

Get smart- Train, train, train…make sure all
Awareness
your clinicians understand the system
in Your

Silent cockpit – Make uninterrupted time for
Team
documentation (cone of silence)

Devote resources to getting this right (time
= money)

Build into QI program

Have a toolbox

List of common or overlooked
diagnoses

Coding desk references

Smartphone or web apps
Undiscovered jewels – think tank with the
Involve your
team…what are we missing
Team in Risk
What have you coded in the past and what’s
Adjustment
missing this time
Processes
Low hanging fruit – what are team members
already documenting but not coding
Make Friends – Who else where you are is
working on this…people in finance, a coder?? Have
a drink together!!
Pep rallies- Keep everyone informed about how
you are doing and brag when things go well!
Use
•Compare current diagnoses to past diagnoses submitted
Your •Coding patterns among providers/sites
•Missing encounters/assessments
Data!
Model Output Report
PDAC Reports
RAPS Return Files
EMR reports
Chronic Conditions can be Slippery fish
If you missed it at an annual or semi,
Chronic
see them again and document.
Conditions
Make sure all chronic conditions are
addressed and documented and
coded at least annually.
Once amputated, never returns –
don’t miss the obvious.
Treatment
is evidence
Sherlock Holmes…look for clues
of
that would indicate a diagnosis
diagnosis

Medication list

Check under the bed – What
have consultants documented that
might not be captured

IDT assessments (esp SW, RN,
Dietician, Rehab)
Don’t Dawdle
As your momma always said-
don’t dawdle.
You can’t get this all done in the
last week…make it a daily
practice.
Anticipate deadlines and
schedule accordingly.
Prepare for Risk
Adjustment Sweep

Risk Adjustment Submission deadlines in March and September

Internal monitoring process to validate that all RAPS data is submitted

Benchmark to submit all eligible RAPS data within 45 days from DOS

Consistency eliminates the last minute data submission pressure and
helps ensure accurate and complete risk adjustment submission.

http://www.npaonline.org/member-resources/payment
Don’t miss the
Compliance
bus:
Dates
for RAPS and EDS files
Ingrain deadlines in your plan at the submitter level and clinician level
Dec 31, 2016 – last date to have face-to-face visit for diagnoses that will ultimately
impact payment for PY 2017
Jan 31, 2017 ( Feb 3, 2017 ) – deadline to
(CMS Memo on 4/20/16) vs CSSC Newsletter Jan 2016
submit diagnosis codes for 2015 dates of service
Mar 3, 2017 – submission deadline for 2016 service dates to use in the 2017 mid-
year model run
Sep 8, 2017 – submission deadline for 2018 Initial Model Run (7/1/16 through
6/30/17 DOS)