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Enhancing Data Quality Management Control Through Effective Audits in TRICARE

This report discusses the implementation and results of the Data Quality Management Control (DQMC) program, specifically focusing on the TRICARE Data Quality Training Course conducted on March 1, 2011. It outlines the methodologies for conducting external coding audits, including the process for inspecting medical records and coding accuracy. The audit results are analyzed for availability and reliability, utilizing intra- and inter-examiner techniques. The findings from random samples of medical records illustrate the ongoing commitment to maintain high standards in medical records coding and data quality across the direct care system.

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Enhancing Data Quality Management Control Through Effective Audits in TRICARE

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  1. DATA QUALITY MANAGEMENT CONTROL (DQMC) PROGRAM(continued) TRICARE Data Quality Training Course March 1, 2011

  2. DQMC ProgramInspections/External Audits FY 2010 MTF External Coding Audit: Process MHS Data Repository Medical Records Coding Audit Paper Records • Audit for availability of record • Audit for accuracy ofof coding • Reliability tests confirmed audit results • Intra-examiner (same auditor – reaudit later in time) • Inter-examiner (different auditor – reaudit) AHLTA Random Sample 7100 records pulled at random SIDRs SADRs MERHCF Random Sample List Medical Record Copy

  3. DQMC ProgramInspections/External Audits 11 random samples of FY 2008 medical records drawn from across the direct care system Total audit size = 7,100

  4. DQMC ProgramInspections/External Audits External Coding Audit Response Rates FY 2010 (Data Records FY 2008)

  5. DQMC ProgramInspections/External Audits External Coding Audit Response Rates FY 2010 (Data Records FY 2008)

  6. DQMC ProgramInspections/External Audits

  7. DQMC ProgramInspections/External Audits

  8. DQMC ProgramInspections/External Audits Note: Quick Fix – send the AHLTA cited documentation

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