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Data Quality Management Control Program. Data Quality Section, PASBA. Overview. Patient Records Accountability Coding Audits Sampling Size and Techniques Inpatient Records Outpatient Records Workload Comparison System Security

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data quality management control program

Data Quality Management Control Program

Data Quality Section, PASBA

slide2

Overview

  • Patient Records Accountability
  • Coding Audits
    • Sampling Size and Techniques
    • Inpatient Records
    • Outpatient Records
  • Workload Comparison
  • System Security
  • System Design, Development, Operations, and Education and Training
  • Regulatory Guidance
  • Program Management
  • Organizational Factors
  • System Inputs,
  • Processes, and Outputs
    • CHCS
    • ADM
    • MEPRS/EAS
    • TPOCS
    • MEWACS
slide4
Regulatory GuidanceDODD 6040.41Medical Records Retention and Coding at Military Treatment Facilities
program management
Program Management
  • Data Quality Manager
  • Data Quality Assurance Team
  • Intermediate Command DQ Manager
  • Service Data Quality Manager
  • DQMC Review List
  • Commanders Monthly Data Quality Statement (internet based)
system inputs processes and outputs
System Inputs, Processes, and Outputs
  • Composite Health Care System (CHCS)
  • Armed Forces Health Longitudinal Technology Application (AHLTA)
  • Ambulatory Data Module (ADM)
  • Medical Expense and Performance Reporting System (MEPRS) / Expense Assignment System (EAS)
  • MEPRS Early Warning and Control System (MEWACS)
  • Defense Medical Human Resources System –Internet (DMHRS-i)
  • Third Party Outpatient Collection System (TPOCS)
data input meprs eas adm chcs tpocs
Data InputMEPRS/EAS, ADM, CHCS, TPOCS
  • Written Procedures
  • Current Versions
  • Upgrades & Updates
  • Rejected Records
  • End of Day Processing
    • Percentage of Clinics
    • Percentage of Appointments
  • Timely Coding Completion
commander s data quality statement
Commander’sData Quality Statement
  • Q. 1. What percentage of appointments was closed in meeting your “End of Day” processing requirements, “Every appointment – Every day?” (B.5.)
commander s data quality statement1
Commander’sData Quality Statement
  • Q. 2. In accordance with legal and medical coding practices, have all of the following occurred:
    • a) What percentage of Outpatient Encounters, other than APVs, have been coded within 3 business days of the encounter? (B.6.(a))
    • b) What percentage of APVs have been coded within 15 days of the encounter? (B.6.(b))
    • c) What percentage of Inpatient records have been coded within 30 days after discharge? (B.6.(c))
data output meprs eas adm chcs tpocs
Data OutputMEPRS/EAS, ADM, CHCS, TPOCS
  • EAS
    • Financial Reconciliation
    • Inpatient and Outpatient Workload Reconciliations
    • MEWACS Review
    • Timely Data Transmittal
    • Workload Comparison
commander s data quality statement2
Commander’sData Quality Statement
  • Q. 3. Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities Manual (MEPRS Manual) DoD6010-13-M, dated April 7, 2008, paragraph C3.3.4, requires report reconciliation (C.1.)
    • a) Was monthly MEPRS/EAS financial reconciliation process completed, validated and approved prior to monthly MEPRS transmission?
commander s data quality statement3
Commander’sData Quality Statement
  • Q. 3. Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities Manual (MEPRS Manual) DoD6010-13-M, dated April 7, 2008, paragraph C3.3.4, requires report reconciliation (C.1.)
    • b) Were the data load status, outlier/variance, WWR-EAS IV, and allocations tabs in the MEWACS document reviewed and explanations provided for flagged data anomalies?
commander s data quality statement4
Commander’sData Quality Statement
  • Q. 3. Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities Manual (MEPRS Manual) DoD6010-13-M, dated April 7, 2008, paragraph C3.3.4, requires report reconciliation (C.1.)
    • c) For DMHRS-i, what is the percentage of timecards submitted by the suspense date?
    • d) For DMHRS-I, what is the percentage of approved timecards by the suspense date?
data output meprs eas adm chcs tpocs1
Data OutputMEPRS/EAS, ADM, CHCS, TPOCS
  • CHCS
    • Duplicate Records
    • Timely Data Transmittal
      • Standard Inpatient Data Record (SIDR)
      • Worldwide Workload Report
    • Inpatient Records
      • Accountability
      • Documentation
      • Coding
      • SIDRs completed (in a “D” status)
    • Workload Comparison
commander s data quality statement5
Commander’sData Quality Statement
  • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).
    • a) MEPRS/EAS (45 calendar days)
commander s data quality statement6
Commander’sData Quality Statement
  • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).

- b) SIDR/CHCS (5th and 20th calendar day of the month)

commander s data quality statement7
Commander’sData Quality Statement
  • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).

- c) WWR/CHCS (10th calendar day following month)

commander s data quality statement8
Commander’sData Quality Statement
  • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3).
    • d) SADR/ADM (daily)
data output
Data Output
  • A minimum of 30 records/encounters should be pulled randomly from the entire population of MTF inpatient medical records for the audit data month.
  • A random audit of 30 records per MTF will provide a statistical confidence level of 90%, with a confidence interval/sampling error range of plus or minus 15%.
  • The PASBA is generating a monthly DD Form 2569 audit pull-list for auditing of other health insurance .
data output inpatient coding
Data OutputInpatient Coding
  • Coding
    • DRG Codes
    • Related Data Elements (C.5)
      • All Diagnoses
      • Any Procedures
      • Sex
      • Age
      • Discharge/Disposition
  • Percentage of SIDRs Completed (D-Status)
commander s data quality statement9
Commander’sData Quality Statement
  • Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)

a) What percentage of inpatient records whose assigned DRG codes were correct?

commander s data quality statement10
Commander’sData Quality Statement
  • Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)
  • b) Inpatient Professional Services Rounds encounters E & M codes audited and deemed correct?
commander s data quality statement11
Commander’sData Quality Statement
  • Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)
  • c) Inpatient Professional Services Rounds encounters ICD-9 codes audited and deemed correct?
commander s data quality statement12
Commander’sData Quality Statement
  • Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j)
  • d) Inpatient Professional Services Rounds encounters CPT codes audited and deemed correct?
data output meprs eas adm chcs tpocs2
Data OutputMEPRS/EAS, ADM, CHCS, TPOCS
  • ADM
    • Timely Data Transmittal
      • Standard Ambulatory Data Record (SADR)
    • Error Logs
    • Workload Comparison
data output outpatient coding
Data OutputOutpatient Coding
  • Sample Size
  • Accountability
    • Percentage Located or Properly Checked Out
    • Checked-out Over 30-Days?
  • DD Form 2569 (Third Party Insurance Information)
commander s data quality statement13
Commander’sData Quality Statement
  • Q.6. Outpatient Records. (c.6.a,b,c,d,e,f)
    • a) Is the documentation of the encounter selected to be audited available? Documentation includes documentation in medical record, loose (hard copy) documentation or an electronic record of the encounter in AHLTA?
data output outpatient coding1
Data OutputOutpatient Coding
  • E&M Codes
  • ICD-9 Codes
  • CPT Codes
commander s data quality statement14
Commander’sData Quality Statement
  • Q. 6. Outpatient Records.
    • b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.)
commander s data quality statement15
Commander’sData Quality Statement
  • Q. 6. Outpatient Records.
    • c) What is the percentage of ICD-9 codes deemed correct?
commander s data quality statement16
Commander’sData Quality Statement
  • Q. 6. Outpatient Records.
    • d) What was the percentage of CPT codes deemed correct? (CPT code must comply with current DoD guidance.)
commander s data quality statement17
Commander’sData Quality Statement
  • Question 7 Ambulatory Procedure Visits (C.7.a,b,c)
  • Questions 7.a,b,c, are the same as Questions 6.a,c,d,,
commander s data quality statement18
Commander’sData Quality Statement
  • Q. 8. Outcome of monthly inpatient audit: (C.8a,b,c,d,e,f)
  • a) What percentage of completed and current (signed within the past 12 months) DD Form 2569s are available for audit?
  • b) What percentage of available, current and complete DD Form 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?
commander s data quality statement19
Commander’sData Quality Statement
  • Q. 8. Outcome of monthly outpatient audit: (C.8a,b,c,d,e,f)
  • c) What percentage of completed & current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) are available for audit?
  • d) What percentage of available, current and completed DD Form 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?
commander s data quality statement20
Commander’sData Quality Statement
  • Q. 9. Comparison of reported workload data (C.9).
    • a) # SADR Encounters (count only visits / # WWR visits
    • b) # SIDR Dispositions / # WWR Dispositions
    • c) # EAS Visits / # WWR Visits
    • d) # EAS Dispositions / # WWR Dispositions
    • e) # IPSR SADR encounters (FCC=A***)/# Sum WWR (Total Bed Days + Total Dispositions + Live Births + Bassinet Days)

Note: Question e, FY11 Goal is 80%.

data output workload comparison
Data OutputWorkload Comparison
  • Q.9a SADR Visits / WWR Visits
    • Should have an equal number of visits.
    • Encounters – Omit Appt. Status of “No-Shows,” “Canceled,” and Disposition Code “Left Without Being Seen”.
    • Encounters – Include Appt. Status “TelCon”
    • Only SADR Records Marked with an Appt. Status of “C” (complete) Are To Be Included.
    • Only “count” encounters are included.
data output workload comparison1
Data OutputWorkload Comparison
  • Q.9b SIDR Dispositions / WWR Dispositions
    • Must Match
    • Only SIDRs With a Disposition of Status of “D” Are To Be Included
    • SIDRs – Exclude Carded for Record Only (CRO) and Absent Sick Records
data output workload comparison2
Data OutputWorkload Comparison
  • Q. 9c EAS Visits / WWR Visits
    • Must Match
    • Include MEPRS Functional Cost Code B** (Outpatient) and FBN (Hearing Conservation)
    • Include APVs
data output workload comparison3
Data OutputWorkload Comparison
  • Q. 9d EAS Dispositions / WWR Dispositions
    • Must Match
    • Only SIDRs with a Disposition Status of “D” are to be included
data output workload comparison4
Data OutputWorkload Comparison
  • Q. 9e IPSR encounters (FCC=A***)/# Sum WWR (Total Bed Days + Total Dispositions + Live Births + Bassinet Days)
    • Must Match
    • Only SIDRs with a Disposition Status of “D” are to be included.
    • Insure WWR calculation includes live births (section 01) and Bassinet Days (section 00).

Note: FY11 Goal is 80%

commander s data quality statement21
Commander’sData Quality Statement
  • Q.10. - System Design, Development, Operations and Education/Training (E.4.i).
    • # AHLTA SADR encounters/# of Total SADR encounters

Note: FY11 compliance goal is 95%..

(* It is understood that not all clinical modules are deployed in the current version of AHLTA.)

commander s data quality statement22
Commander’sData Quality Statement
  • Q.11.- CHCS software used during the data month to identify duplicate patient registration records. (C.2a)

- What was the number of potential duplicate records in the reporting month?

commander s data quality statement23
Commander’sData Quality Statement
  • Q.12.- Provide the number of incomplete and non-transmitted SIDRs for the month. (F.1)

Note: This question on the DQ Statement is only a requirement for Army sites and will not be reported to TMA.

commander s data quality statement24
Commander’sData Quality Statement
  • Q.13.a.- Provide the number of loose forms/documents/papers that are currently waiting to be filed, either electronically or in the hard-copy medical record. (F.2.a)

Note: This question on the DQ Statement is only a requirement for Army sites and will not be reported to TMA.

commander s data quality statement25
Commander’sData Quality Statement
  • Q.13.b.- Provide the number of loose forms/documents/papers that are currently waiting to be filed, either electronically or in the hard-copy medical record, 30 days after an active duty soldier has retired or separated from the service. (F.2.b)

Note: This question on the DQ Statement is only a requirement for Army sites and will not be reported to TMA.

commander s data quality statement26
Commander’sData Quality Statement
  • Q. 14. – I am aware of data quality issues identified by the completed Commander’s Statement and Review List and when needed, have incorporated monitoring mechanisms and have taken corrective actions to improve the data from my facility.
security
Security
  • Are there internal controls and procedures in place to approve and manage assignment of security key privileges?
  • Have all security key holders been identified and their need for security key privileges validated by the CIO or designee?
system design operations and education training
System Design, Operations, and Education/Training
  • System Administrator Appointed In Writing for Each System
  • Training and Education Procedures and Documentation
  • System Change Request Process
  • System Incident Report
  • Routine Maintenance
  • Points of Contact for Equipment Failure Issues
  • Contingency Plans
  • Trouble tickets
data quality section pasba
Data Quality Section, PASBA

Chief DQ Section PASBA

Tim Bacon, 210-295-8725

Joseph.Bacon@amedd.army.mil

slide53

METRIC MANIA

Department of Army

TMA metrics

Review

&

Analysis

Strategic Readiness System

(SRS)

OTSG

BALANCED

SCORECARD

Command Management System

(CMS)

Why should you care? What can you do to help?

slide54

MEDCOM STRATEGY MAP

  • GOALS:
  • Improve overall health & wellness of
  • enrolled beneficiaries.
  • Improve patient access and satisfaction.
  • Improve effectiveness of peacetime direct care system.
slide55

KEYS TO SUCCESS

  • Improve Data Quality Efforts
  • Cultural Change
  • Improve Access to Care
  • Tie Financing to Performance
    • PBAM – Performance Based Adjustment Model
slide56

Army Health System

Army Health System

WT Population ~ 12,000

MEDCOM Capacity (Human Capital)

65+

Total MEDCOM

DHP Human Resources

AD

Medical

Green-Suit

Military

Ret/RetFM (<65)

ADFM

MEDCOM direct care capacity cannot meet the Healthcare demand of the around 3 million eligible beneficiaries (MEDCOM cares for 1.414 million enrolled & 300K users)

Reasons include:

-Population dispersion (especially among Retirees & their Families)

-Efficiency demands (numerous small population centers)

-Military structure supports Readiness – not peacetime healthcare

Population Requiring Healthcare (Demand)

slide57

Overall Satisfaction With Health Plans

“And the Winner is…” Managed Care Magazine, September 2008 pp 41-46

Data -Wilson Health Information LLC Annual Survey Jan-Feb 2008

slide58

DATA QUALITY

  • Increased emphasis on MTF submissions
  • Improved reporting timeliness
  • Improved accuracy
  • SIDRs
  • SADRs
  • MEPRS
slide59

Enrollment Capacity Forecast Model (ECFM)

  • Combines Multiple Data Systems
    • Current Enrollment (ECM)- Assumes Historical Space-A work
    • Potential Enrollment (MTF Business Plans)
    • EBSM- Forecast population changes
    • Ops- UNCLASSIFIED Deployments and Redeployments by location by month
    • ARTS- Deployed personnel from MTF
  • Provides Adjusted Enrollment for those Active duty deployed, and redeploying
  • Adjusts MTF enrollment capacity based on deployed PCMs (1000/Per deployed PCM)
  • Future Development to include:
    • Adjustments for Backfilling PCMs from another MTF
    • Forecast ARTS deployments- (Pending Deployments)
    • Deployment to CMS
slide60

USE OF THE DATA

TMA = Gospel

“Garbage In, Garbage Out”

OTSG = Disaster

MTF = Nuclear Fire Storm

slide61

Priorities

  • The data matter
  • Cultural shift
  • Use the CMS
  • Ask: What are we
  • asking our staff to do?
slide62

Standardize Core R&A for

Medical Treatment Facilities

  • No standard R&A approach in MEDCOM
  • MTF Cdrs create their own “TOC”
  • MTF’s spend a lot of time designing/developing
  • the “TOC”
  • Cdrs and staffs learn together at the expense of
  • Organizational Performance
  • R&A provides the Azimuth….critical to direction
  • and success
slide63

Core Measures for MTFs

  • Enrollment
  • Productivity
  • Access
  • Patient Satisfaction
  • Coding Accuracy
  • Prevention/HEDIS
slide64

End-of-Day (EOD) Processing

MTF staff will determine the status of each appointment as accurately as

possible. EOD processing will be correctly completed at the end of each

business day.

Pending: The MTF appointment information system assigns this initial status

for an appointment that has been booked for a patient for a future date or time.

All pending appointments must be changed to one of the final encounter

statuses in order to complete End-of-Day processing.

Kept: The patient has a booked appointment, arrives at the MTF/clinic, and is

treated by provider.

Walk-in: The patient does not have a scheduled appointment, arrives at the

clinic, and is assigned a time to see the provider the same day. This status

will not be changed at End-of-Day processing.

Sick Call: An Active Duty member arrives at a clinic for a pre-arranged block

of time for care. This status will not be changed at End-of-Day processing.

slide65

End-of-Day (EOD) Processing

Patient Cancellation: A patient with a scheduled appointment notifies

The MTF in accordance with local procedures that they will not keep the

appointment.

No-Show: A scheduled appointment that the patient does not keep.

Determinations of no-shows will be in accordance with local procedures.

Facility Cancellation: The MTF cancels an available/open appointment

or cancels a patient’s scheduled appointment.

Left Without Being Seen: The patient has a booked appointment, arrives

at the clinic, and is checked in, but decides to leave without seeing the

provider.

Admin: The admin status is used on appointments or telephone consults

that do not represent actual contact with a patient. The status must be

Assigned in End-of-Day processing. A transaction with this status will not be

passed to ADM or AHLTA and will not be coded or included in SADR.

slide66

End-of-Day (EOD) Processing

Occasions of Service: This status on a patient appointment indicates no

medical decision was made by a privileged provider who is directly

Responsible for the management of care for the patient. This status will

no longer be used on telephone consults. This transaction will pass from

CHCS to the Ambulatory Data Module (ADM), is always non-count, and may

be used to assess level of effort. ADM and AHLTA do not recognize this

status as an appointment for completion. Therefore this status will NOT

prompt the provider to code the encounter and will avoid generating a

Standard Ambulatory Data Record (SADR).

Telephone Consultation: When a provider answers a telephone consult in

AHLTA, the provider will be asked by the system, “Does this meet the out-

patient visit criteria?” If the provider is a technician, nurse, or other non-

count provider or the clinic is a non-count clinic, the workload type response

will be defaulted to No (non-count) and cannot be changed in AHLTA. If the

provider is a privileged provider and the clinic is a count clinic, the default

will be Yes (count). The provider should change the response to No if it

does not meet the visit criteria.

slide67

Walk-ins

  • 1. A walk-in is a patient who seeks care without a scheduled appointment,
  • Arrives at the clinic, and is assigned a time to see the provider the same day.
  • There is no ATC Standard for walk-in appointments.
  • Walk-ins are not designed for use as a schedulable event.
  • High utilization of walk-ins can create data quality challenges for the
  • MTF and make the process of measuring/explaining access, and assessing
  • demand more complex.
  • High rates of walk-ins may also make business plan targeting difficult since they
  • are unplanned events.
  • Excessive walk-in activity can reduce the appointments available to patients
  • requesting care on the telephone.
  • However, if clinics utilize the walk-in function to get patients seen in a manner
  • that is more timely/convenient for the patients, this is recognized as good customer
  • service from the patient’s perspective.
slide69

Medical Expense and Performance Reporting System (MEPRS)

  • The DoD Manual 6010.13-M, MEPRS for Fixed Medical and Dental Treatment
  • Facilities. Provides a definition of MEPRS codes (also know as functional cost
  • codes, FCC).
  • Define your CHCS File-and-Build Hospital Locations so that each clinic has
  • only one associated MEPRS code.
  • Ensure that each MEPRS code has the four characteristics of:
  • a. A defined physical space (e.g., square footage)
  • b. Associated expenses (e.g., supplies)
  • c. Associated personnel time (e.g., work hours) and
  • d. Associated workload (e.g., visits, procedures, etc.)
  • Manual provides definition and criteria of a visit (count vs. non-count)
  • Defense Medical Human Resources System – internet (DMHRS-i), there has
  • been significant improvement in timecard reporting. Need to pay attention
  • to the accuracy of the information being entered into the system.
slide85

Auditing for DD Form 2569, Other Health Insurance

  • Non active duty only.
  • MEPRs FCC of “B” and “FBN”.
  • Eliminated all “B” MEPRS which have a fourth level code of 2.
  • Minimum of 50 encounters for SADRs, SIDRs, APVs. (Encounters for parent and child MTF)
  • Increased number of encounters pulled for MTFs when requested.
  • Randomly selected encounters.
slide91

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