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Air Force TMA DQ Course Break-Out Session. AFMOA/SGAR. May 10 . Air Force TMA DQ Course Break-Out Session Overview. Organization MTF Engagement Why is DQ Important? HSI Requirements Resources DQ Assurance Team CHCS Provide File Other DQ Efforts DQ Review List/Statement Completion .

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Air force tma dq course break out session

Air Force TMA DQ Course Break-Out Session

AFMOA/SGAR

May 10


Air force tma dq course break out session overview

Air Force TMA DQ Course Break-Out Session Overview

Organization

MTF Engagement

Why is DQ Important?

HSI Requirements

Resources

DQ Assurance Team

CHCS Provide File

Other DQ Efforts

DQ Review List/Statement Completion


Afmoa goals

AFMOA Goals

Patient-centered healthcare

Currency platforms supporting innovative en route care and deployed medical ops

Progressive reduction of waste in healthcare ops

Precise application of resources to requirements


Integrated approach

Integrated Approach

MEPRS

Personnel

Workload

Financial

Data Quality

Data Quality

Patient

&

Provider

Coding

SIDR/SADR

MSDRG/RWP

RVU/CPT

UBO

Other Health Insurance

Eligibility

Demographics

Data Quality

Data Quality


Data quality dq roles and responsibilities

Data Quality (DQ) Roles and Responsibilities

DQ Program Manager

DQ Program Analyst

DQ SME

DQ SME

  • Provide CHCS Database Admin SME support

  • -- ID & assist MTFs correct: (Provider File errors, Hospital Location Files,

  • site definable MEPRS tables, clear incomplete ancillary results

  • Create CHCS restrictions/draft business rules to promote standardization

  • Develop CHCS training guides to promote MTF Data Quality

  • Provide Ad Hoc report assistance to support MTF data pulls

  • Perform MTF site visits to provide on-site technical assistance

  • Develop performance metrics to validate improvement efforts

  • Focal point for MTF’s DQ Mgmt

  • Control Program/DQ Statement

  • Teams to provide policy/MTF’s

  • business practice improvements

  • Biometric data consultant

  • Measures MTF/AFMS DQ

  • performance & influences change

  • - Trains MTF DQ Managers

  • Mission:

  • Provide Comprehensive DQ - Program Management to all MTFs

  • Provide reachback support to MAJCOMs and DRUs

  • Key Objectives:

  • Standardize Methodology

  • Evaluate Processes

  • Reduce Variance

  • Future Initiatives:

  • Consolidation

  • Shape MHS/AFMS DQ efforts

  • Field Electronic DQ Statement


Mtf dq engagement

MTF DQ Engagement

  • One-on-one support

    • Telephone

    • E-mail: [email protected]

    • Defense Connect Online (DCO)

      • Similar to “Go to Meeting”

  • MTF-AMFOA DQ Telecons every other month

    • PACAF, CONUS, USAFE

    • Business and training conducted

    • Schedule for CY10 on Vector Check

    • DCO is the primary tool used to conduct meetings and take attendance


Defense connect online

Defense Connect Online

Find meeting here

Meetings found will be shown here.

  • To become a registered user visit: https://www.dco.dod.mil


Defense connect online1

Defense Connect Online

You can chat here. If we are in the middle of training thru DCO we will be unable to respond during that time.


Mtf dq engagement cont

MTF DQ Engagement (cont)

  • AF portion of the TMA DQ Course

  • Other training/interaction forums:

    • Annual RMO Conf, UBO/U Conf, etc….

  • Site Visit philosophy evolution

    • Exhaust all other means prior to on-site support

    • Hard-broke, smaller portion of a larger purpose visit

  • Optimize use of Vector Check

    • Tools/resources/announcements/schedule….eDQ


Mtf dq engagement cont1

MTF DQ Engagement (cont)

  • Vector Check - “Think of Vector Check as your DQ Toolkit”:

  • Share Point application; primary website for the AFMOA DQ

  • Must have a Kx (AFMS Knowledge Exchange) https://kx.afms.mil membership before you can access Vector Check

  • Once you have obtained a Kx membership, and are still unable to access Vector Check, contact AFMOA POC

    • Include your name, e-mail, and DSN

    • Turnaround time is 24-48 hours

  • Visit the AMFOA DQ site at:

  • https://vc.afms.mil/afmoa/sga/sgar/sgardq/default.aspx\


Vector check alerts

Vector Check Alerts

Click on your name.


Vector check alerts1

Vector Check Alerts

Click on My Settings.


Vector check alerts2

Vector Check Alerts

Click on My Alerts.


Vector check alerts3

Vector Check Alerts

Click on Add Alert.


Vector check alerts4

Vector Check Alerts

Select which item you would like to be alerted to when new information is posted.

After selection is made click on next.


Vector check alerts5

Vector Check Alerts

Select criteria of the alerts you want to be notified on.

After selection is made click on OK.


Vector check alerts6

Vector Check Alerts

This will show you what alerts you are signed up for. Follow this process for each alert.


What is available on vector check

What is available on Vector Check?


Why is data quality important

Why is Data Quality Important?

To accurately reflect the work performed in your MTF


Air force tma dq course break out session

Data quality Management Controls are the driving force and conduit for ensuring effective and efficient operations

Visual review for validating and streamlining major clinical business and resource management processes

MTF Patient Accounting

& Revenue Cycle

Claims

Account

Follow-up

Production Value

(RVUs/RWPs)

Cost per RVU/RWP

(Efficiency)

Coding

Denial

Mgmt

CCE

UR/UM

Referral

Mgmt

EWRAS

TPOCS/

CMBB

Payment

Posting

ADM/

P-GUI/

CHCSII

Data Quality Management

Electronic

Billing

Pre-cert/

Auth

Appeals

CHCS

(Files &

Tables)

M2

Data Mart

Encounter

Document

Payer

Education

MEPRS

(MEWACS)

Patient

Check-in

Ins Verify &

Auth

Contract

Mgmt

Patient

Access

Resourcing

(Money, Manpower, and Materiel)

MTF Business Plan

(Patient Management)

Improved patient access, records documentation and coding accuracy

Results are increased resourcing with reliable outcomes in the form of usable data


Integrated approach1

Integrated Approach

MEPRS

Personnel

Workload

Financial

Data Quality

Data Quality

Patient

&

Provider

Coding

SIDR/SADR

MSDRG/RWP

RVU/CPT

UBO

Other Health Insurance

Eligibility

Demographics

Data Quality

Data Quality


Dq system architecture

DQ System Architecture

Interface Errors

Clinical

Data Mart

Air Force

TRICARE

Ops Center

CCQAS

Worldwide Workload Report

Service Repository (BDQAS)

WWR

(Count Visits)

DoD/VA

FHIE/BHIE SHARE

MHS Data Repository

MDR

Coding Compliance

Editor

SADR

CAPER

(Encounters)

CCE

PDTS

Standard Ambulatory

Data Record

Pop Health

Portal

Pharmacy Data

Transaction

System

ADM

SADR 1/SADR 2

EAS IV

Extract

MHS Mart

M2

Essentris

EAS

Repository

TPOCS

Billable

Encounters

WAM

Count Visits & Raw Services

EAS IV

“Eligible” Encounters

CPT Codes

Units of Service


How is your data used

How is your data used?

  • BRAC

  • Monitor efficiency of the healthcare system

  • Performance Based Budgeting

    • Prospective Payment System - PPS

  • Medicare Accrual Fund

  • MTF Business Plans

  • Provider/Clinic Workload Productivity

  • Determine Level of Effort by all clinic staff

  • Reimbursements (TPC, Coast Guard, NOAA…etc)

  • Enable the Leadership to make informed decisions


Dq success factors

DQ Success Factors

Active leadership involvement

Knowledgeable Data Quality Manager

Engaged Data Quality Team

MTF analysis of data and metrics

File/Table Build, provider profiles, database management

Patient demographics: gathering/verification

Timely and accurate coding

End-of-day processing

Data reconciliation and audits


Hsi requirements

HSI Requirements

  • Data Quality Manager appointment letter

  • Commander’s DQ Statements (previous 12 months)

  • DQ Assurance Team meeting minutes (previous 2 years).

  • The MTF/CC appointed a DQ Manager who is responsible for accomplishing Data Quality Management Control (DQMC) activities

    • Completes the DQMC Review List and briefs results to the MTF Executive Committee

    • A DQ Assurance Team was established (or an existing structure was tasked) to monitor financial and clinical workload DQ assurance and management controls

    • Team members included, as a minimum, the DQM, MEPRS Manager, Budget Analyst, RMO, Medical CIO, and GPMs

  • MEPRS data was reconciled and validated prior to entry into EAS


Dq toolkit a k a vector check

DQ Toolkit…a.k.a. Vector Check

“Think of Vector Check as your DQ Toolkit” – key components in your toolkit:

  • Data Quality Manager’s User Guide (DQ MUG)…DQ Team User Guide (DQ TUG)

    • Reporting Consistency

    • Training document for new personnel

  • CHCS Provider File Continuity Guide – “How to” guide produced to assist MTFs in the provider data cleanup process

  • AFMS Workload Guidelines

    • Version 2.0

    • Brings together DQ, MEPRS, Coding and Billing

    • AF supplemental guidance to DOD coding guidelines

  • Training Slides


Dq mug

DQ MUG

  • Primary AF Specific DQ Guidance

    • DQ Statement clarification

      • TUG focuses on DQ Review List vs. Statement (prep for eDQ)

    • Formulas/background info/how to get the data

  • Share MUG with your entire DQ team (TUG vs. MUG)

  • Discuss MUG at your DQ meeting to ensure it is read and understood by those answering DQ Statement questions

  • Living document...updated during the year as needed

  • Published by HAF DQ

  • DQ MUG Sample:


Dq mug format

DQ MUG Format

8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions?

8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions?

Performance Threshold:

Greater than or equal to 95%; GREEN

Greater than or equal to 80% but less than 95%; YELLOW

Less than 80%; RED

The Air Force Standard for this metric is 95% or greater.

  • Calculation:

  • EAS Total Dispositions

  • -----------------------------------

  • WWR Total Dispositions

  • Details:

  • This question is only applicable to facilities with inpatient services. This is the ratio of EAS IV inpatient visits to the inpatient dispositions reported in the WWR. The EAS IV dispositions and visits are the numbers submitted by the MTF as of the suspense date and are downloaded from the AMPO repository. Please check with your RM or MEPRS staff to validate the information. If your MTF have submitted a corrected EAS IV or have made a late transmission, let BDQAS staff know to refresh the data and update their files. Insure corrections made in one data system are also made in the others.

  • Process:

  • Recommended process is to go to the BDQAS web site at:

  • https://bdqas.brooks.af.mil/data_metrics/data_metrics.htm

    • Go to Data Quality Reports-Data Quality Statement Reports.

    • Find your Major Command, then your Facility and then the correct reporting month.

    • Find the monthly percentage for Question 8d.

https://kx.afms.mil/kxweb/dotmil/file/web/ctb_117012.pdf


Workload guidelines sample

Workload Guidelines Sample

  • Supplements AF Coding Guidelines

  • Published by AF Coding Experts

https://kx.afms.mil/kxweb/dotmil/file/web/ctb_098772.pdf


Best practices

Best Practices

  • Current Best Practices Posted on Vector Check

    • FY 10 DQMC Review List in Excel Format

    • Sample DQ Agenda

    • Sample DQ Minutes

  • Future Best Practices

    • DQ Assurance Team slides

    • DQ Executive Committee Brief

    • Training slides

    • DQ initiatives

  • Please submit any potential best practices for possible inclusion


Dq assurance team

DQ Assurance Team

  • Documentation of minutes and briefings should be on file for a minimum of 2 years

  • The Data Quality Assurance Team or other designated structure met during the reporting month to complete the DQMC Review List

  • Team members, as a minimum will be the DQ Manager, MEPRS Manager, Budget Analyst, RMO, Medical CIO, and Group Practice Managers

    • Although not a requirement, recommend a coder/coding auditor, ancillary services representative, and clinic support staff representative attend meetings

  • Provide oversight of the provider file clean-up and maintenance

  • Develop DQ initiatives


Dq assurance team initiatives interest items

DQ Assurance TeamInitiatives - Interest Items

  • Proper CHCS File/Table set up

    • File/Table updates, Clinic/Provider profiles

    • Appointment standardization

  • Assigning Workload to the Proper MEPRS/FCC Codes

    • Account Subset Definition (ASD) Table Reconciliation

    • Inappropriate MEPRS Codes

  • Patient Registration/Admissions/Front Desk Duties

    • Verify Eligibility in DEERS

    • Gather/Verify Demographics and OHI

  • Coding

    • Documentation must record what actually occurred

    • Ensure Accuracy/Completeness

    • TMA Annual Coding Audit tracking


Dq assurance team initiatives interest items cont

DQ Assurance TeamInitiatives - Interest Items (cont)

  • Patient safety

  • CHCS Training

  • Accountability

  • Improve data accuracy

    • Include critical data elements

    • Correct critical data elements

  • Capture workload and revenue opportunities


Chcs provider file background

CHCS Provider File Background

  • 584,000+ provider file records across the AF

    • 37,500 new provider file records created each year since 2001

    • Average MTF error rate is 46.36% (Not all errors are equal, some are administrative, while others are show stoppers (possibly affect patient safety and reimbursements)

  • Initial central correction efforts began at SG8Y

    • Each MTF ran provider file pulls and sent them to SG8Y

    • Manual analysis of provider file errors conducted

    • Site Analysis Reports (SAR) produced for each MTF

      • Cumbersome (7+ page word document/problems embedded)

    • Lack of performance metrics

    • Inconsistent Follow-up

  • Scope and impact of this problem required a new approach


New and improved provider file correction process

New and Improved Provider File Correction Process

  • Central DSS Provider File pull with a focus on last 2.5 yrs of activity (1 APR 07 to Today)

  • Air Force Specific Initiative

  • Automated query identified potential errors and improvement opportunities

  • Results exported into an Access database

    • Produces a “Detail Report” for each facility

      • Actionable listing of MTF specific entries requiring attention

      • Enables MTF to use limited resources on problem resolution

      • Drillable to focus correction efforts

    • Generates a MTF “Provider File Report Card”


Chcs provider file errors and error criteria

CHCS Provider File Errors and Error Criteria


Chcs provider file errors and error criteria cont

CHCS Provider File Errors and Error Criteria (cont)


Impacts to provider file errors

Impacts to Provider File Errors

  • What are the potential impacts of incorrect or null data in the CHCS provider file?

    • Patient Safety

    • Revenue

    • Workload

    • Data Integrity


Potential revenue impact

Potential Revenue Impact

  • Pharmacy makes up 70 to 80% of your facilities collections

  • Average # Claims for Outside Provider Scripts per month

    • Large Facility 1,500-3,000

    • Medium Facility700

    • Small Facility300

  • Average Amount Billed per claim: $50

  • If your provider file has 100 outside providers that issued at least one script per month with missing data in their profile: provider specialty codes, NPI (new requirement mid FY08), DEA #, provider name and ID.

    • Potential Loss is $5,000 in billable claims per month

    • Potential Loss is $60,000 in billable claims per year


Air force tma dq course break out session

Volume and error types will dictate cleanup strategies

Monthly error rates for the MTF


Provider report card continued page 2

Provider Report Card(continued – page 2)

Peer Group Comparison


Provider details report

Provider Details Report


Afmoa dq provider file roles responsibilities

AFMOA DQ Provider File Roles/Responsibilities


Afmoa chcs provider file resolution guide

AFMOA CHCS Provider File Resolution Guide

  • Guide is available on Vector Check

  • Description of each provider field

  • Correction instructions

  • CHCS screen shots

  • CHCS menu path/secondary menu information

  • CHCS maintenance reports

  • Potential impact

  • Recommended Office of Primary Responsibility

  • Training Slides also available to supplement Resolution Guide


Mtf dq team provider file roles responsibilities

MTF DQ Team Provider File Roles/Responsibilities


New and improved provider file way ahead

“New and Improved” Provider File Way Ahead

  • Active ongoing support of MTF improvement efforts

  • Further refine approach based on MTF feedback

  • Enhance tool documentation

  • Increased reporting frequency (monthly vs. quarterly)

  • Share reports with MTF Leadership

  • Improvement progress tracked on Vector Check

  • AFMOA UFR to centrally procure HCIdea website subscription for MTFs to support their correction efforts, $50K annually


Other data quality efforts

Other Data Quality Efforts

All

CHCS

Files

Patient File Related


Patient registration dq team

Patient Registration DQ Team


Patient registration dq team cont

Patient Registration DQ Team (cont)


Patient registration dq team cont1

Patient Registration DQ Team (cont)


Automating duplicate patient merge adpm initiative

Automating Duplicate Patient Merge (ADPM) Initiative


Adpm initiative cont

ADPM Initiative (cont)


Adpm initiative cont1

ADPM Initiative (cont)

- Theater Medical Data System (TMDS) - AHTLA/CDR - CHCS


Dq review list statement reminders

DQ Review List/StatementReminders

  • Refining/expanding beyond DQ statement…TUG

  • Internal tool to assist in identifying and correcting financial and clinical workload data problems

  • Monthly Requirement

  • All variances should be briefed with DQ Team and Executive Committee

  • DQMC Review List is required to have all supporting summary documentation kept on file for five years

  • eDQ will be based on the Review List

  • MTFs need back up plans for Data Quality and all other areas that support completing the Review List.


Dq review list statement reminders1

DQ Review List/Statement Reminders

  • The due date is NLT the 25th of the month. If the 25th falls on a weekend, please have statement submitted the Friday prior

  • Submitted Spreadsheet to AFMOA should match exactly what the CC signed

  • The coding audit due dates changed in April. The audit previously was due approximately the 20th of each month but now is due approximately on the 15th of each month

    • The auditors still have over a month to complete the audit

  • Timeliness and Accuracy Metric


Dq review list statement comments

DQ Review List/Statement Comments

  • Do not use ‘see item above’

  • Must have problem, corrective action plan, and estimated completion date (include trouble tickets, if applicable)

  • Clear and concise

  • Required all areas in red

  • Please check spelling on comments, numerous typos on many

  • Don’t use “I” since the CC is signing the Statement, it would infer that the CC couldn’t get a task complete

  • Comments included on your MTF Statement are posted word for word on TMA and vector check websites

  • Upwards trend of comments not being related to question

    • I.e.. Inpatient comments given for outpatient question (vice versa)


Dq review list dq assurance team meeting

DQ Review List DQ Assurance Team Meeting

  • Question A.3. The DQ Assurance Team or other designated structure met during the reporting month to complete the DQ Management Control Review List. (Recommend attaching meeting minutes).

    • “Yes” = Green “No” = Red (comments required)

    • Do not use N/A


Dq review list executive committee brief

DQ Review List Executive Committee Brief

  • Question A.4. The DQ Manager briefed the reporting month’s DQ Management Control Review List, and Financial and Workload Data Reconciliation and Validation results to the MTF Executive Committee.

    • “Yes” = Green “No” = Red (comments required)

    • Do not use N/A


Dq review list statement completeness

DQ Review List/StatementCompleteness

  • Question B.5.a. (DQ Statement question 1.a.) In the reporting month (include only B*** and FBN* accounts):

    • a) What percentage of appointments were closed in meeting your “End of Day” processing requirements, “Every appointment – Every day?” (B.5.(b)) Source is BDQAS

      Number of closed appointments

      Total appointments for the month

    • > 97% = Green> 80% < 97% = Yellow < 80% = Red


Dq review list statement bdqas

DQ Review List/StatementBDQAS

  • https://bdqas.brooks.af.mil/index2.htm

  • Biometric Data Quality Assurance Service (BDQAS) is a source for many DQ Statement questions

  • Updated on the 10th or 11th for non-EAS data

  • EAS data on BDQAS is updated between the 16 thru 20th

    • If EAS transmission did not occur on-time, questions that are applicable to EAS will need to be manually calculated and annotated on Statement as such


Air force tma dq course break out session

Select Data Metrics


Air force tma dq course break out session

Select Data Quality Statement Reports


Air force tma dq course break out session

Select the command for your MTF


Air force tma dq course break out session

Select your MTF and then the data month

These are the questions and percentages for each question BDQAS pulls

Note: Manual procedures in DQ MUG if needed


Dq review list statement timeliness

DQ Review List/StatementTimeliness

  • Question B.6. (DQ Statement question 2.) In accordance with legal and medical coding practices, have all of the following occurred:

    • B.6.a (DQ Statement question 2.a.) What percentage of Outpatient Encounters, other than APVs, has been coded within 3 business days of the encounter? Source is BDQAS

    • B.6.b (DQ Statement question 2.b.) What percentage of APVs have been coded within 15 days of the encounter? Source is BDQAS

    • B.6.c (DQ Statement question 2.c.) What percentage of Inpatient records have been coded within 30 days after discharge? Source, run inpatient timeliness adhoc found on BDQAS

    • > 95% = Green> 80% < 95% = Yellow < 80% = Red


Dq review list statement validation and reconciliation

DQ Review List/StatementValidation and Reconciliation

  • Question C.1. (DQ Statement questions 3 series) Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities Manual (MEPRS Manual), DoD 6010.13-M, dated April 7, 2008, paragraph C3.3.4, requires report reconciliation.

    • C.1.a (DQ Statement question 3.a.) Was monthly MEPRS/EAS financial reconciliation process completed, validated and approved prior to monthly MEPRS transmission? Source is MEPRS Manager and RMO Office

    • C.1.c. (DQ Statement question 3.c.) Were the data load status, outlier/variance, WWR-EAS IV, and allocations tabs in the current MEWACS document reviewed and explanations provided for flagged data anomalies? Source is MEPRS Manager (note: need to answer C.1.c.1 through C.1.c.4)

    • Yes = Green No = Red (comments required) Do not use N/A


Dq review list s tatement mewacs

DQ Review List/StatementMEWACS

  • Proactively identify, investigate, and resolve MEPRS data anomalies in a timely, systematic manner

  • Data Quality Statement question 3b.

  • Data that is identified as erroneous should be fixed and retransmitted

  • MEWACS is normally updated approximately on the 16th of each month

  • TMA centrally tracks site “hits” by base…compare outliers to hits

  • AFMOA MEPRS uses Vector Check to help identify outliers prior to them becoming outliers on MEWACS

  • Download the MEWACS Excel file for the Review Month from the MEWACS web site at http://www.meprs.info/mewacsxls.cfm


Air force tma dq course break out session

User guide is very helpful step by step tool. Also you can download an excel file of you MEWACS info.

Click here


Air force tma dq course break out session

Data Load Status

Summary Outliers

WWR/EAS IV

Allocation Test


Air force tma dq course break out session

Data Load Status


Air force tma dq course break out session

Summary Outliers


Air force tma dq course break out session

WWR/EAS IV


Air force tma dq course break out session

Allocation Test


Afmoa meprs dashboard

AFMOA MEPRS Dashboard

  • Launched MEPRS Dashboard Oct 2009

    • Objectives:

      • Identify variance

      • Evaluate processes

      • Provide training

    • Measures:

      • 20 Key data points with supporting detailed reports

    • Controls:

      • 1 or 2 standard deviations

      • Upper-Lower controls

    • Visibility: Resides on Vector Check – Enterprise-Wide Access

      https://vc.afms.mil/AFMOA/SGA/SGAR/SGAR_MEPRS/default.aspx

76


Afmoa meprs dashboard nellis afb nov 2009

AFMOA MEPRS Dashboard Nellis AFB, Nov 2009

Validated

Error

Error

Error

Research

Error

Error

Errors

77


Afmoa meprs dashboard nellis afb apr 2010

AFMOA MEPRS Dashboard Nellis AFB, Apr 2010

Corrected

Corrected

Validated

Corrected

Research

Research

Corrected

Corrected

Corrections Pending

78


Dq review list statement validation and reconciliation1

DQ Review List/StatementValidation and Reconciliation

  • Question C.1.e. & f. (DQ Statement question 3.c) Continued…New Questions on Timecards submitted by close of business the Monday after the end of the pay period

    • C.1.e. (DQ Statement question 3.c.) For DMHRSi, what is the percentage of submitted timecards by the suspense date?Source is MEPRS Manager

      Number of Timecards Submitted On-time

      Total Number of Timecards for an MTF

    • C.1.f (DQ Statement question 3.c.) For DMHRSi, what is the percentage of approved timecards by the suspense date?Source is MEPRS Manager

      Number of Timecards Approved On-time

      Total Number of Timecards for an MTF

    • = 100% = Green < 100% = Red


Dq review list statement comments1

DQ Review List/Statement Comments

  • Question C.1.e. and C.1.f., comments are required if under 100%

  • Question C.1.f.

    • Not only about submission, but also approval

      • If the percentage you have here is less than the submitted percentage, then you need to explain what is the problem with the approval process

    • Cannot be greater than C.1.e.

    • This percentage is not calculated by the percentage of timecards approved that were submitted. This percentage is calculated out of the entire number of timecards that should have been submitted.

  • NOTE: TUG will require comments for all yellow/red thresholds


Dq review list statement chcs duplicate patients

DQ Review List/Statement CHCS Duplicate Patients

  • Question C.2. (DQ Statement question 10.) CHCS software used during the reporting month to identify duplicate patient registration records. (C.2a)

    • a)  What was the number of potential duplicate records in the reporting month? (NOTE: Only Host sites report up.)Source is Internal Process

      Run the CHCS standard report – “Potential Duplicate Patient Search”.

    • Report Ran = Green Report Not Ran = Red (comments required)

    • Only use N/A if your MTF is not a CHCS Host Site


Patient duplicate reporting

Patient Duplicate Reporting

  • For CHCS/AHLTA hosts only, what was the number of potential duplicate records in the data month for all MTFs under the host? Run the CHCS standard report – “Potential Duplicate Patient Search”

    • Report all potential duplicates regardless of service!

    • Even if you are not a ‘parent’ but someone uses your platform, your facility needs to report all the potential duplicates on your host

    • It is understood that running the CHCS Potential Duplicate Patient Report will give the total on the host server and individual MTFs can’t be shredded out by DMIS ID

      • However, the report will show who registered the patient so there is a way to identify who entered the duplicates incorrectly


Patient duplicate reporting1

Patient Duplicate Reporting

  • Do you have a process to reduce the number of duplicate records?

    • Potential duplicate patient records can be minimized by performing DEERS validation checks.

  • Has your MTF determined how to correct the duplicate appointments/encounters and avoid the errors in the future?

  • Have trouble tickets been filed with MHS Helpdesk for duplicate records in CHCS/AHLTA that cannot be resolved at the MTF level?

  • List all sites being reported (including host) by DMIS ID and DMIS facility name in the comments section


Patient duplicate reporting2

Patient Duplicate Reporting

  • DISCLAIMER: We know this is not catching all duplicate patients. Do not use this to gauge the health of your patient file on your CHCS platform. Would recommend on occasion running the “ALL” report and Registration report. However, for DQ reporting purposes, the Registration report number is what should be on the Statement.

  • Just because DQ is asking for the Potential Duplicate Patient Report, does not exclude a facility from running the required monthly PIT Error Discrepancy Report and working them separately. Two different requirements and two different problems.

    • Might see some crossover that the same patient’s are on both reports, but this is normal


Dq review list statement compliance

DQ Review List/Statement Compliance

  • Question C.3. (DQ Statement series 4 questions.) Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).*

    • C.3.a. (DQ Statement question 4.a.) MEPRS/EAS (45 days) Source is MEPRS Manager/MEWACS

    • C.3.b. (DQ Statement question 4.b.) SIDR/CHCS (5th Duty of Day of the month) Source is BDQAS

    • C.3.c. (DQ Statement question 4.c.) WWR/CHCS (10th Calendar Day Following Month) Source is BDQAS

    • For C.3.a.-C.3.c.: Yes = Green No = Red (comments required)

    • C.3.d. (DQ Statement question 4.d.) SADR/ADM (Daily) Source is BDQAS

    • > 95% = Green> 80% < 95% = Yellow < 80% = Red


Dq review list statement coding accuracy calculation

DQ Review List/Statement Coding Accuracy Calculation

  • Use the following formulas for Q5b-d(Internal Process),6b-d(Audit Tool),7b-c(Audit Tool):

    • ICD-9: Number of correct ICD-9 codes

      Total number of ICD-9 codes

    • E&M: Number of correct E&M codes

      Total number of E&M codes

    • CPT: Number of correct CPT codes

      Total number of CPT codes


Afms coding in transition

AFMS Coding In Transition

  • Diverse MAJCOM and MTF contract solutions

    • Inconsistent coding

      • Staffing models

      • Workload requirements

      • Training practices

      • Performance/DQ

      • Funding sources with variable reliability

  • Self-Audits are common and not objective

  • Fragmented comm b/n MTF, MAJCOM, HQ AFMS

  • Suboptimal compliance w/ AMA/DoD/AFMS guidance

  • AFAA audit conclusion: “Medical coding effectiveness required significant improvement in all areas”


  • Afaa afms coding findings

    AFAA: AFMS Coding Findings

    • “MTF personnel were inappropriately allowed to use the same contractor for both coders and auditors, creating a significant conflict of interest”

    • “All 9 MTFs had coding error rates of 50% or higher”

    • “36% of encounters contained diagnoses coding errors, increasing the potential for subsequent providers to incorrectly treat or delay patient treatment”

    • “Medical personnel did not identify specific system and coding training needs, develop a reliable plan to address providers’ needs, or adequately track provider training”


    Afaa recommendations agreed to by af sg

    AFAA Recommendations agreed to by AF/SG

    • “Create a centralized AFMS outpatient coding contract to place a pre-determined number of coding support personnel at every MTF”

    • “Require independent auditors accomplish AFMS audits”

    • “Establish and implement an Air Force-wide training plan to educate and train providers on coding requirements to include DoD, Air Force, and AMA standards”

    • “Implement procedures to track providers’ coding performance, to identify providers’ coding strengths and weaknesses, and provide individualized training to correct deficiencies”


    Coding initiative objectives

    Coding Initiative Objectives

    Robust support is paramount

    Standardization is attainable and pragmatic but will not succeed without leadership endorsement

    Dispel the myth that “More coding is better”

    New focus on coding only what is needed

    Utilize IM/IT systems to fullest potential

    Target training based upon identified errors

    Ongoing provider training is vital!

    Endorse continued evaluation for

    Dynamic enhancements (address lessons learned)

    Incorporation of billing and coding into one contract


    Air force tma dq course break out session

    Central Coding Contract

    Why

    • Centralization of coding and auditing contracts was driven by AFMS, AFAA, and AF/SG concerns

    • Centralization equivocally aligns the coding and auditing assets across all CONUS MTFs

    • Centralization answers the requirement to eliminate biased self-auditing practices

    • Provider workload driven by this change is small

    • Coding 100% of encounters is expensive and does not provide better data quality

    • Centralized concept saves AFMS dollars and provides higher fidelity coding


    Air force tma dq course break out session

    AFMS Coding Contract

    Way Ahead

    • Centralized Coding Contract

      • Outpatient Coding support for CONUS* MTFs

        • All ER and APU (Procedure visit) encounters coded

        • All Billables/TPCs will be coded

        • Additional 10% of outpatient visits coded

      • Strong emphasis on Coding Trainers

        • Provide general & targeted instruction

      • 100% coding model not chosen because evidence does not show it improves DQ, and it is high cost ($40M+)

    • Centralized Auditing Contract

      • Remote cell apart from MTFs, utilize CAT/CARS

      • Audit, track, report and communicate training needs

    • Develop similar vehicle for true OCONUS sites


    Afms coding contract way ahead cont

    AFMS Coding ContractWay Ahead (cont)

    • AFMS Centralized Coding and Auditing Contracts

    • Two distinct contracts

    • Answers 6 AFAA identified deficiencies

    • Standardizes workload and resources to all MTFs

    • Objectively audits coding at every MTF

    • Supports provider education and training needs

    • Coordinates management through AFMOA

    • Meets urgent expiration deadlines for 36 MTFs

    • $12.6M uniform solution vs. $20.5M disparate model

  • Maintaining the status quo would not address AFMS needs or AFAA recommendations


  • Air force tma dq course break out session

    AFMS Coding Contract Conclusion

    • Centralization of coding and auditing contracts was driven by AFMS, AFAA, and AF/SG concerns

    • Centralization equivocally aligns the coding and auditing assets across all CONUS MTFs

    • Centralization answers the requirement to eliminate biased self-auditing practices

    • Provider workload driven by this change is small

    • Coding 100% of encounters is expensive and does not provide better data quality

    • Centralized concept saves AFMS dollars and provides higher fidelity coding


    Dq review list statement compliance1

    DQ Review List/Statement Compliance

    • Question C.5. (Data Quality Statement 5 series questions) Outcome of monthly inpatient coding audit

      • C.5.c) Percentage of inpatient records whose assigned DRG codes were correct?

      • C.5.f) Inpatient Professional Services Rounds encounters E & M codes audited and deemed correct?

      • C.5.g) Inpatient Professional Services Rounds encounters ICD-9 codes audited and deemed correct?

      • C.5.h) Inpatient Professional Services Rounds encounters CPT codes audited and deemed correct?

      • > 95% = Green> 80% < 95% = Yellow < 80% = Red


    Dq review list statement availability accuracy

    DQ Review List/Statement Availability/Accuracy

    • Question C.5. Inpatient Records (continued)

    • C.5.i) What percentage of completed and current (signed within the past 12 months) DD Forms 2569 (TPC Insurance Info) are available for audit? (How the patient answered is only relevant to answering “Question 6f”)

      • The DD Forms 2569 need to be available and current at the time of the audit to be in compliance with the UBO program.

      • > 95% = Green> 80% < 95% = Yellow < 80% = Red

      • Options for filing DD Form 2569:

        • Maintain hardcopy DD Form 2569 in medical record

        • Scan DD Form 2569 and store electronically

        • Hardcopy DD Form 2569 stored in the MTF RMO/Business/TPC Office


    Afms tpc central contract in transition

    AFMS TPC Central Contract In Transition


    Dq review list statement availability accuracy1

    DQ Review List/Statement Availability/Accuracy

    • Question C.5. Inpatient Records. CONT…

      • C.5.j) What percentage of available, current and complete DD Forms 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?

        Internal Process based on Question 6e. Does not apply to OCONUS bases.

      • > 95% = Green> 80% < 95% = Yellow < 80% = Red


    Dq review list statement availability accuracy2

    DQ Review List/Statement Availability/Accuracy

    • Question C.6. (Data Quality Statement series 6 questions) Outpatient Records

      • C.6.a) Is the documentation of the encounter selected to be audited available? Documentation includes documentation in the medical record, loose (hard copy) documentation or an electronic record of the encounter in AHLTA. (Denominator equals sample size.)

      • C.6.b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.)

      • C.6.c) What is the percentage of ICD-9 codes deemed correct?

      • C.6.d) What is the percentage of CPT codes deemed correct? (CPT code must comply with current DoD guidance.)

        Source for a, b, c, d is Audit Tool

    • > 95% = Green> 80% < 95% = Yellow < 80% = Red


    Dq review list statement availability accuracy3

    DQ Review List/Statement Availability/Accuracy

    • Question C.6. Outpatient Records (continued)

    • C.6.e) What percentage of completed and current (signed within the past 12 months) DD Forms 2569s (TPC Insurance Info) are available for audit?

    • Audit Tool Generated/Internal Process (This metric only measures whether or not a DD Form 2569 was collected/current in the record at the time of the encounter).

      The DD Forms 2569 need to be available and current at the time of the audit to be in compliance with the UBO program.

      • C.6.f) What percentage of available, current and complete DD Forms 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?

        Internal Process based on Question 6e.Does not apply to OCONUS bases.

      • > 95% = Green> 80% < 95% = Yellow < 80% = Red


    Dq review list statement availability accuracy4

    DQ Review List/Statement Availability/Accuracy

    • Question C.7. Ambulatory Procedure Visits (Data Quality Statement series 7 questions) (C.7.a,b,c,d,e)

      • Questions C.7.a,b,c,d,e Are the same as Questions C.6.a,c,d,e,f

      • > 95% = Green> 80% < 95% = Yellow < 80% = Red


    Dq review list statement completeness1

    DQ Review List/Statement Completeness

    • Question C.8. (Data Quality Statement series 8 questions) Comparison of reported workload data.

      • C.8.a) # SADR Encounters (count only) / # WWR visits Source is BDQAS

      • C.8.b) # SIDR Dispositions / # WWR Dispositions Source is BDQAS

      • C.8.c) # EAS Visits / # WWR Visits Source is BDQAS

      • C.8.d) # EAS Dispositions / # WWR Dispositions Source is BDQAS

      • C.8.e) # of Inpatient Professional Services Rounds SADR encounters (FCC=A***)/#Sum WWR (Total Bed Days + Total Dispositions) Note: FY10 Goal is 80% (Will be graded red and green only)

        Source is Monthly Statistical Report (Internal Process)

    • > 95% = Green> 80% < 95% = Yellow < 80% = Red


    Dq review list statement ahlta use

    DQ Review List/Statement AHLTA Use

    • Question E.4.i. (Data Quality Statement question 9) System Design, Development, Operations, and Education/Training.

      • a. # of AHLTA SADR encounters / # of Total SADR encounters (ALL SADR encounters including APV and ER)

        Source is BDQAS

        Note: This question is to gauge the use of AHLTA at our MTFs. It is understood that not all clinical modules are deployed in the current version of AHLTA.

      • > 80% = Green < 80% = Red


    Dq statement awareness

    DQ Statement Awareness

    • Question 11. I am aware of data quality issues identified by the completed DQ Statement and DQMC Review List and when needed, have incorporated monitoring mechanisms and have taken corrective actions to improve the data from my facility. (Electronic Signature Authorized)

      • “Yes” = Green “No” = Red (comments required)

      • Do not use N/A


    Electronic dq edq review list and statement

    Electronic DQ (eDQ) Review List and Statement

    • Automate DQ Review List and Statement production at the MTF

    • Eliminate repetitive consolidation at various higher HQ levels

    • Will enable all involved to spend more time correcting DQ, improving processes, enhance decision making

    • Development originally linked to Vector Check design/deployment

      • Stalled for a variety of reasons: differing corporate memory; funding/EOY; evolving requirement request processes

    • Way Ahead (No firm ECD, but it’s coming):

      • Prototype almost complete

      • AFMOA leadership recently funded to completion

      • Deploy at test sites/collect feedback…adjust…deploy AF-wide

      • Design/implement performance metrics


    Edq access via vector check

    eDQ Access via Vector Check


    Edq review list main page

    eDQ Review List Main Page


    Edq review list sample view

    eDQ Review List Sample View


    Edq rejection sample

    eDQ Rejection Sample


    Important references

    Important References

    • DODI 6015.1-M, DOD Glossary

    • DODI 6010.13M, MEPRS Program for Fixed MTFs and DTFs

    • DODI 6010.15M, Uniform Business Office

    • DODI 6040.40, Data Quality Program

    • DODI 6040.41, Medical Records Retention and Coding at MTF

    • DODI, 6040.42, Medical Encounter and Coding at MTF

    • DODI, 6040.43, Custody and Control of Medical Records

    • AFI 41-102, AF MEPRS Program for Fixed MTFs and DTFs

    • AFI 41-120, Resource Management Operations

    • AFI 41-210, Patient Administration Functions

    • DoD Professional Coding Guidelines

    • AF Workload Standardization Guidelines

    • EASIV Reference Guide


    Useful web sites

    Useful Web Sites

    • Data Quality

      http://www.tricare.mil/ocfo/mcfs/dqmcp/management_control.cfm

    • BDQAS - https://bdqas.brooks.af.mil/index2.htm

    • UBU - http://www.tricare.mil//ocfo/bea/ubu/index.cfm

    • UBO - http://www.tricare.mil/ocfo/mcfs/ubo/about.cfm

    • MEPRS – http://meprs.info

    • DMHRSi - https://dmhrsi.satx.disa.mil

      https://kx.afms.mil/kxweb/dotmil/kj.do?functionalArea=DMHRS1

    • MEWACS - http://www.meprs.info/mol3/mol3.cfm

    • DFAS -  https://mypay.dfas.mil/mypay.aspx

    • HIPAA -  http://tricare.osd.mil/ocfo/mcfs/ubo/hipaa.cfm

    • SAIC -  http://www.chcs-dm.com/


    Useful web sites cont

    Useful Web Sites (cont)

    • Vector check - https://vc.afms.mil/afmoa/sga/sgar/sgardq/default.aspx\

    • NPPES - https://nppes.cms.hhs.gov/NPPES/Welcome.do

    • HCIdea - http://www.hcidealookup.org

    • Knowledge Exchange - https://kx.afms.mil


    Take aways

    Take Aways

    • DQ is much more than the DQ statement

    • Data needs to be accurate, complete and timely

    • Front-end processes are CRITICAL to back-end success


    Air force tma dq course break out session summary

    Air Force TMA DQ Course Break-Out Session Summary

    Organization

    MTF Engagement

    Why is DQ Important?

    HSI Requirements

    Resources

    DQ Assurance Team

    CHCS Provide File

    Other DQ Efforts

    DQ Review List/Statement Completion


    Data quality program office

    Data Quality Program Office

    Data Quality Umbrella

    MTF

    Questions?

    Data Quality

    Foundation


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