Headquarters U. S. Air Force I n t e g r i t y - S e r v i c e - E x c e l l e n c e U.S. AIR FORCE Data Quality Management Control (DQMC) Program Air

Headquarters U. S. Air ForceI n t e g r i t y - S e r v i c e - E x c e l l e n

c e

U.S. AIR FORCEU.S. AIR FORCEU.S. AIR FORCEU.S. AIR FORCE

Data Quality Management Control (DQMC) Program

Air Force Data Quality Manager

Shirley Williams/David Brunner

CHCS Data Analysis

AFMOA/SG3YR

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Overview

Data Quality (DQ) Program Systems DQ Composite Healthcare Computer System

(CHCS) Initiatives FY08 Updates Take Away Questions


DQMC Program

Data Quality Manager

Data Quality Assurance Team

DQMC Review List

Commander’s Monthly Data Quality Statement

INSTRUCTION

Department of Defense

DODI 6040.40Military Health System

Data Quality Management Control Procedures


DQ Team Roles and Responsibilities

Team Key Players DQ Manager Group Practice Manager (GPM) Medical Expense Reporting System (MEPRS) and Credentials Manager Budget Analyst/Uniform Business Office (UBO) Coding/Billing Supervisor Clinical Systems Administrator(s)

DQ team meets monthly Keep meeting minutes for at least two years Review Metrics Report monthly to Executive Committee

It is great to look – But are you working toward improvement?


“E” – Support “D” – Ancillary “A” – Inpatient “B” – Outpatient “C” – Dental

+ “F” – Special Programs

+ “G” – Readiness

EAS IVMoney

Manpower

Workload

CRIS

EAS-SA

CHCS / WAM

(Count only)

RECONCILE

Direct Care “Step Down”

Medical Expense Performance & Reporting System“MEPRS” -- Valuation

Defense Health Program Cost Accounting

OUTPUT

TotalCost

RVUs RWPs

ICD/E&M/CPTDRGsSIDR

SADRCHCS


DQ Team Responsibilities Cont…

DQMC Review List Maintained locally Tool to assist Military Treatment Facilities (MTFs) in identifying and

correcting financial and clinical workload data problems monthly

Commander’s Data Quality Statement Facility Report Card Specific information from the DQMC Review List Commander signs/approves monthly Forwarded through the MAJCOM to AF DQ Manager


Commander’s DQ StatementCompleteness

Question 1. In the reporting month (include only B*** and FBN* accounts):

a) What percentage of clinics have complied with “End of Day” processing requirements, “Every clinic – Every day?

Sum of Daily Totals of Open Clinics Successfully Completing EOD Processing Sum of All Daily Totals of Open Clinics

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

Sum of Daily Totals of Successfully Closed Appointments

Total Appointments


Commander’s DQ StatementTimeliness

Question 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?

BDQAS b) What percentage of APVs have been coded within 15 days of the

encounter?

BDQAS c) What percentage of Inpatient records have been coded within 30 days

after discharge?

Internal Process

CCE Report (Un-coded records report)


Question 3. In accordance with TMA policy, “Implementation of EAS/MEPRS Data Validation and Reconciliation,” dated 21 Dec 99 and “MEPRS Early Warning and Control System,” dated 28 May 02, along with the most current Service-Level Guidance

a) Was monthly MEPRS/EAS financial reconciliation process completed, validated and approved prior to monthly MEPRS transmission?

MEPRS Manager and RMO Office b) Question 3b-has been omitted for FY08 and Questions 3c was

renumbered 3b b) 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?

MEPRS Manager

Commander’s DQ StatementValidation and Reconciliation


Commander’s DQ StatementCompliance

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

a) MEPRS/EAS (45 days)

MEPRS Manager/MEWACS b) SIDR/CHCS (5th Duty of Day of the month)

BDQAS c) WWR/CHCS (10th Calendar Day Following Month)

BDQAS d) SADR/ADM (Daily)

BDQAS


Question 5. Outcome of monthly inpatient coding audit:

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

b) Inpatient Professional Services Rounds encounters E & M codes audited and deemed correct?

c) Inpatient Professional Services Rounds encounters ICD-9 codes audited and deemed correct?

d) Inpatient Professional Services Rounds encounters CPT codes audited and deemed correct? a) Percentage of inpatient records whose assigned DRG codes were correct?

Commander’s DQ StatementCompliance


Question 6. Outpatient Records

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.)

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

c) What is the percentage of ICD-9 codes deemed correct?

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

a, b, c, d-Audit Tool Generated

Commander’s DQ StatementAvailability/Accuracy


Question 6. Outpatient Records. CONT…

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

Audit Tool Generated/Internal Process (This metric only measures whether or

not a DD2569 was collected/current in the record at the time of the encounter.

How the patient answered is only relevant to answering “Question 6f”)

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

Internal Process based on Question 6e (Only current and signed DD2569

whether there yes or no are checked)



Question 7. Ambulatory Procedure Visits (C.7.a,b,c,d,e)

Question 7b deleted and c,d,e,f renumbered Questions 7.a,b,c,d,e Are the same as Questions 6.a,c,d,e,f



Question 8. Comparison of reported workload data.

a) # SADR Encounters (count + non-count) / # WWR visitsBDQAS

b) # SIDR Dispositions / # WWR DispositionsBDQAS

c) # EAS Visits / # WWR Visits BDQAS

d) # EAS Dispositions / # WWR DispositionsBDQAS

e) # of Inpatient Professional Services Rounds SADR encounters (FCC=A***)/#Sum WWR (Total Bed Days + Total Dispositions) Note: FY08 Goal 80%

Internal Process (Monthly Statistical Report)

Commander’s DQ StatementCompleteness


Question 9. System Design, Development, Operations, and Education/Training (E.4.a).

a. # of AHLTA SADR encounters / # of Total SADR encounters

Note: Exclude APV (B**5, 7,8,9) and ER (BIAA)

FY08 not scored. For management use and tracking purposes only.

BDQAS Question 10. 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. (Electronic Signature Authorized)

Commander’s DQ StatementAwareness


Air Force

DQ System Architecture

MDRMDR

M2M2

WWR(Count Visits)

EAS IVEAS IV“Eligible” Encounters

CPT Codes Units of Service

WAMWAMCount Visits & Raw Services

SADR(Encounters)

TPOCSTPOCSBillable

Encounters

PDTSPDTS

Worldwide Workload Report

Standard Ambulatory Data Record

EAS Repository

ADMExtract

MHS Data Repository

MHS Mart

Service Repository (BDQAS)

Pharmacy Data Transaction System

Pop HealthPortal

CCE

Coding Compliance Editor

ClinicalData Mart

TRICAREOps Center

DoD/VA SHARE

SADR 1/SADR 2


DQ Monitoring Tools

MHS Management Analysis and Reporting Tool (M2) Used to extract data for PPS and AF Business Plan Need to identify the M2 user in your facility Tricare Management Activity (TMA) WISDOM course

EASIV Repository MEPRS data

Cost per data 45 day processing period for current month

MEPRS Manager TMA MADI Course


MEWACS Trend analysis tool Outlier indications

Review and correct data accordingly Outliers are not always incorrect data

BDQAS Data Quality Statement Reports

Compare and report values on DQ statement Consistent reporting for questions:

2a-b, 4b-d, 8a-d, 9 “Point-in-time" reports

Updated on the 20th of the month Display by MTF or MAJCOM

Contact BDQAS helpdesk for data inconsistencies or questions

DQ Monitoring Tools Cont…


BDQAS




BRAC Monitor efficiency of the healthcare system Performance Based Budgeting – 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

How is your data used?


Provider File

Civilian (Outside) Provider File Pharmacy/Lab/Rad are required to add the Civilian Provider to CHCS

Create a local policy/standard operating procedure Educate and train the ancillary staff Use correct PSC linked to HIPAA Taxonomy

Provider naming convention and DEA/License number should be strictly enforced and monitored Last Name Middle Name or Initial (if available)

Last name,First Name No spaces between first and last name No punctuation other than comma between names, with the

exception of hyphenated names No professional titles in name, e.g., MD, DO

Example: Smith / Johnson,S / Provider / Outside Provider NPI/DEA/License # can be researched on the web using the HCIDEA or

the NEPPES websites


Provider Profiles (con’t)PROVIDER: SMITH, JOHN R Name: SMITH, JOHN RProvider Flag: PROVIDERProvider ID: Provider1234NPI Type/ID: Provider Class: DocPerson Identifier: 123-45-6789Person ID Type Code: Select PROVIDER SPECIALTY: 517 (DENTAL CONSULTANT)Primary Provider Taxonomy:CMAC Provider Class: -Select PROVIDER TAXONOMY:HCP SIDR-ID:Location: CHAMPUS SUPPORT Class: OUTSIDE PROVIDER Initials: JRS SSN: 123-45-6789 DEA#: 99999999License #:

PROVIDER: SMITH,JOHN R Name: SMITH,JOHN R Provider Flag: PROVIDERProvider ID: SMITHJRNPI Type/ID: 01/0125899Provider Class: OUTSIDE PROVIDERPerson Identifier: Person ID Type Code: Select PROVIDER SPECIALTY: 001 (FAMILY PRACTICE PHYSICIAN)Primary Provider Taxonomy: 207Q00000XCMAC Provider Class: -Select PROVIDER TAXONOMY:HCP SIDR-ID:Location: CHAMPUS SUPPORT Class: OUTSIDE PROVIDER Initials: JRSSSN: 123-45-6789 (Not Mandatory)DEA#: BM1212127 License #:


Pharmacy makes up 70 to 80% of your MTFs collections Average # Claims for Outside Provider Scripts per Month

Large Facility 1500-3000 Medium Facility 700 Small Facility 300

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, 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

Potential Revenue Impact


Enter Provider Specialty Code (Be specific – not general) All PA’s – Provider Specialty Code 901 All Technicians – Provider Specialty Code 900 Independent Duty Medical Technician – Provider Specialty Code 521

Lost revenue for codes 500 – 518 and 910 – 999 Zero workload RVU Prevent Encounter from flowing to TPOCS Impact on PPS

Provider Specialties 910 and above are Clinical Services 923-Family Practice Clinic/001-Family Practice Physician 949-Pediatric Clinic/040-Peditrician

Provider Specialty Codes


Value of Care

PEDIATRICS – BDA Provider Specialty Code = 040

Pediatrician

Diagnosis Codes 204 Lymphoid Leukemia 112.89 Candidial Endocarditis

Procedure Code 90780 Intravenous infusion for

therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour

90781 – Each additional hour

E&M Code 99214 – Level 4 Established Patient

OHI – Yes

CMAC Value = $130.73 Class 1 Provider

Will you bill for this patient? Yes Reimbursement - $130.73

PPS RVU = 1.44 Reimbursement = $106.56

PEDIATRICS – BDA Provider Specialty Code = 949

Pediatrics

Diagnosis Codes 204 Lymphoid Leukemia 112.89 Candidial Endocarditis

Procedure Code 90780 Intravenous infusion for therapy/diagnosis,

administered by physician or under direct supervision of physician; up to one hour

90781 – Each additional hour

E&M Code 99214 – Level 4 Established Patient

OHI – Yes

CMAC Value = UNKNOWN

Will you bill for this patient? NO Reimbursement $0

PPS Workload = ZERO!!!!!!ZERO!!!!!!


Today’s Situation

Lack of Training No standard guidance and policies across the AFMS Minimal accountability Potential fraudulent billing Inaccurate Data

Missing Critical Data Elements Incorrect Critical Data Elements

Loss revenue opportunities


CHCS DQ Initiative Roadmap

CHCS DQ Initiative Roadmap

Site Preparation Package – Initiate Site Visit Templates

Complete Langley AFB Site Visit , and Follow-Up Analysis

Data Analysis – Validate and identify DQ problems, Additional Site Visit, and Performance Metrics

Monitor and Follow-up SAR Feedback ; Complete LA/Vandenberg AFB Site Visit

Complete Luke AFB Site Visit, and Follow-up Analysis

CHCS DQ Second Release Site Analysis Report

Update Technical Guide and Patient File Continuity Book, Additional Site Visit

Begin Phase IIl Site Analysis; Complete Academy/Buckley/Peterson AFB Site Visit

Complete CHCS DQ Training Questionnaire, and Feedback

Oct-Nov 07

Nov-Dec 07

Dec- Jan 08

Jan – Feb 08

Feb–Mar 08

Mar- Apr 08

Apr-Jun 08

June-Aug 08

We are here:•Site Analysis of 63 sites

Aug- Sep 08 Performance Metric, Complete Site Visits

Sep-Oct 07


FY08 DQ Updates

FY08 Review List Changes Removed many redundant questions Consolidated questions

FY08 Commanders Statement Changes Question 3b- Removed--Were monthly inpatient and outpatient workload reconciliation

processes completed? Question 5a- Wording change - What percentage of inpatient records whose assigned DRG

codes were correct? Question 7b-Removed Question 8a-Added “count + non-count” to the statement Question 9-Now excludes ER (AF no change) Question 10-Wording Change--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.

Audit Tool Monthly Patient record pull list will now be released on the 13 of every month

Workload Guidelines version 2.0 Supersedes version 1.1 Release Date 1 Oct 07


DQ Tool Kit

DQ Guide Reporting Consistency Assistance with answering questions General DQ information

CHCS DQ Continuity Handbook CHCS standards Processes/procedures for addressing CHCS issue and resolution Reports

FY07 Workload Guidelines Version 2 Brings together DQ, MEPRS, Coding and Billing AF supplemental guidance to DOD coding guidelines

Data Quality Web Page AFMS Knowledge Exchange Documents (Site Analysis Report), briefings, policies/directives, training,

links, discussion threads


DQ Web Page

Contact:

Ms. Michele Gowen, RHIA, CCSAir Force Data Quality Program Manager

Tel (703) 681-6504 DSN 761Fax (703) 681-6011 DSN 761

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


Take Away

DQ is not just the DQ statement.

Data needs to be accurate, complete and timely.

Cleaning the front end will show a return on the back end


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

Data Quality - http://tricare.osd.mil/ocfo/mcfs/dqmcp/training.cfm BDQAS – https://bdqas.brooks.af.mil/index2.htm P2R2 - https://p2r2.hq.af.mil/ UBU - http://tricare.osd.mil/ocfo/bea/ubu/index.cfm UBO - http://tricare.osd.mil/ocfo/mcfs/ubo/index.cfm MEPRS – http://meprs.info MEWACS -

http://www.tricare.osd.mil/ebc/rm_home/mewacs/index.html AF/SGY-https://kx.afms.mil/kxweb/dotmil/kj.do?

functionalArea=DataQuality DFAS - http://www.dash.mil/money/milpay/ Pop Health - https://phsd.afms.mil/phso/ HIPAA - http://tricare.osd.mil/ocfo/mcfs/ubo/hipaa.cfm SAIC - http://www.chcs-dm.com/


QUESTIONS?