2. Excellent Healthcare, Clinical Currency Air Force Medical Operations Agency Air Force TMA DQ Course Break-Out Session 1 AFMOA/SGAR Mar 2011

3. Excellent Healthcare, Clinical Currency 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 2

4. Excellent Healthcare, Clinical Currency Organization HAF/SG8Y (policy)AFMOA (execution) Chief, Financial Performance Program Manager AF Interim DQ Manager Program Analyst DQ Subject Matter Expert DQ Subject Matter Expert 3

5. Excellent Healthcare, Clinical Currency 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 4

6. Excellent Healthcare, Clinical Currency AFMOA/SGAR 5 Chief, Resource Management Division Chief, Resource Operations Branch MEPRS Director Data Quality Director UBO Director

7. Excellent Healthcare, Clinical Currency Integrated Approach 6 MEPRS Personnel Workload Financial UBO Other Health Insurance Eligibility Demographics Coding SIDR/SADR MSDRG/RWP RVU/CPT Patient & Provider Data Quality

8. Excellent Healthcare, Clinical Currency DQ Program Manager Mr. Powers DQ Program Manager Mr. Powers DQ Program Analyst DQ SME Data Quality (DQ) Roles and Responsibilities - 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 - 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 Mission: - Provide Comprehensive DQ - Program Management to all MTFs - Provide reachback support to MAJCOMs and DRUs Mission: - Provide Comprehensive DQ - Program Management to all MTFs - Provide reachback support to MAJCOMs and DRUs Key Objectives: - Standardize Methodology - Evaluate Processes - Reduce Variance Key Objectives: - Standardize Methodology - Evaluate Processes - Reduce Variance Future Initiatives: - Consolidation - Shape MHS/AFMS DQ efforts - Field Electronic DQ Statement Future Initiatives: - Consolidation - Shape MHS/AFMS DQ efforts - Field Electronic DQ Statement

9. Excellent Healthcare, Clinical Currency MTF DQ Engagement One-on-one support Telephone E-mail: afmoa.dq@us.af.mil 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 CY11 on Vector Check DCO is the primary tool used to conduct meetings and take attendance

10. Excellent Healthcare, Clinical Currency Defense Connect Online Find meeting here Meetings found will be shown here. To become a registered user visit: https://www.dco.dod.mil

11. Excellent Healthcare, Clinical Currency 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.

12. Excellent Healthcare, Clinical Currency DQ Telecon Attendence

13. Excellent Healthcare, Clinical Currency 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

14. Excellent Healthcare, Clinical Currency 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

15. Excellent Healthcare, Clinical Currency Vector Check Alerts 14 Click on your name.

16. Excellent Healthcare, Clinical Currency Vector Check Alerts 15 Click on My Settings.

17. Excellent Healthcare, Clinical Currency Vector Check Alerts 16 Click on My Alerts.

18. Excellent Healthcare, Clinical Currency Vector Check Alerts 17 Click on Add Alert.

19. Excellent Healthcare, Clinical Currency Vector Check Alerts 18 Select which item you would like to be alerted to when new information is posted. After selection is made click on next.

20. Excellent Healthcare, Clinical Currency Vector Check Alerts 19 Select criteria of the alerts you want to be notified on. After selection is made click on OK.

21. Excellent Healthcare, Clinical Currency Vector Check Alerts 20 This will show you what alerts you are signed up for. Follow this process for each alert.

22. Excellent Healthcare, Clinical Currency Vector Check RM Master Roster Vector Check RM Master Roster Updates https://vc.afms.mil/AFMOA/SGA/SGAR/default.aspx The following positions are the individuals we need updated: MDG Commander MDG Deputy Commander MDSS Commander Administrator RMO RMO NCOIC DQ Manager DQ Alternate Recommend that Budget Analyst, MEPRS, and UBO staff update their primary and alternate information 21

23. Excellent Healthcare, Clinical Currency Vector Check RM Master Roster 22 Click on Resource Management Master Roster Updates

24. Excellent Healthcare, Clinical Currency Vector Check RM Master Roster 23 Click on Installation Name and then click on your base

25. Excellent Healthcare, Clinical Currency Adding a New POC 24 Click on New and then click on New Item

26. Excellent Healthcare, Clinical Currency 25 Input all information and then click OK Adding a New POC

27. Excellent Healthcare, Clinical Currency Editing a POC 26 Click on Actions and then click on Edit in Datasheet

28. Excellent Healthcare, Clinical Currency Editing a POC 27 Click on Installation Name and then click on your base

29. Excellent Healthcare, Clinical Currency Editing a POC 28 Type over any line item that needs to be fixed For positions not filled, ttype vacant for last name

30. Excellent Healthcare, Clinical Currency What is available on Vector Check?

31. Excellent Healthcare, Clinical Currency 30 Why is Data Quality Important? To accurately reflect the work performed in your MTF

32. Excellent Healthcare, Clinical Currency MTF Patient Accounting & Revenue Cycle Results are increased resourcing with reliable outcomes in the form of usable data Improved patient access, records documentation and coding accuracy 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 CHCS (Files & Tables) MEPRS (MEWACS) MTF Business Plan (Patient Management) Resourcing (Money, Manpower, and Materiel) Patient Access Contract Mgmt Payer Education Appeals Payment Posting Denial Mgmt Account Follow-up Claims Coding UR/UM Referral Mgmt Pre-cert/ Auth Encounter Document Patient Check-in Ins Verify & Auth Production Value (RVUs/RWPs) Data Quality Management ADM/ P-GUI/ CHCSII EWRAS CCE TPOCS/ CMBB Electronic Billing M2 Data Mart Cost per RVU/RWP (Efficiency)

33. Excellent Healthcare, Clinical Currency 32 DQ System Architecture Air Force MDR M2 WWR (Count Visits) EAS IV “Eligible” Encounters CPT Codes Units of ServiceWAM Count Visits & Raw Services SADR CAPER (Encounters) TPOCS Billable Encounters PDTS Worldwide Workload Report Standard Ambulatory Data Record EAS Repository EAS IV Extract MHS Data Repository MHS Mart Service Repository (BDQAS) Pharmacy Data Transaction System Pop Health Portal CCE Coding Compliance Editor Clinical Data Mart TRICARE Ops Center Interface Errors DoD/VA FHIE/BHIE SHARE AD M SADR 1/SADR 2 Essentris CCQAS

34. Excellent Healthcare, Clinical Currency 33 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

35. Excellent Healthcare, Clinical Currency 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 34

36. Excellent Healthcare, Clinical Currency HSI Requirements DOCUMENT LIST Data Quality Manager appointment letter Commander’s DQ Statements and DQMC Review List (previous 12 months – DoDI 6040.40 requires these be maintained for the previous 5 years). DQ Assurance Team meeting minutes (previous 2 years). ELEMENT 3.2.2. CHECKLIST The MTF/CC appointed a DQ Manager and Alternate who are responsible for accomplishing DQMC activities Completes the DQMC Review List monthly DQ Manager briefs DQMC Review List and Financial and Workload Data Reconciliation and validation results monthly to the MTF Executive Committee

37. Excellent Healthcare, Clinical Currency HSI Requirements A DQ Assurance Team was established (or an existing structure was tasked) and met monthly 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, GPMs, and Patient Administration DQAT developed/monitored corrective action plans for all negative findings on the DQMC Review List Maintain DQMC summary supportive documentation for all DQMC Review List questions

38. Excellent Healthcare, Clinical Currency 37 DQ Toolkit…a.k.a. Vector Check “Think of Vector Check as your DQ Toolkit” – key components in your toolkit: Data Quality 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

39. Excellent Healthcare, Clinical Currency DQ TUG 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 TUG with your entire DQ team Discuss TUG at your DQ meeting to ensure it is read and understood by those answering DQ Statement and Review List questions Living document...updated during the year as needed Published by HAF DQ DQ TUG Sample:

40. Excellent Healthcare, Clinical Currency 39 8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions? Resources DQ TUG Format

41. Excellent Healthcare, Clinical Currency 40 Resources DQ TUG Format

42. Excellent Healthcare, Clinical Currency 41 Workload Guidelines Sample Encounter Activity Provider Type Provider Specialty Code MEPRS Code for Time Capture MEPRS Code for Workload Count/Non- Count indicator Patient Encounter Business Rules Coding Required Billing Required Nutritionist/ Dietitian Privileged Provider 704 - Dietician/ Nutritionist B*** CountRegistered dieticians or licensed nutrition Professionals are responsible for providing medical nutrition therapy (MNT). Yes - Supplements AF Coding Guidelines - Published by AF Coding Experts - MHS Coding Guidelines, inpatient and outpatient, dated 1 January 2011 http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm

43. Excellent Healthcare, Clinical Currency Best Practices Current Best Practices Posted on Vector Check Excel version of the TUG to include FY11 DQMC Review List and Statement in Excel Format Sample DQ Agenda and 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

44. Excellent Healthcare, Clinical Currency 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, Group Practice Managers, and Patient Administration Although not a requirement, recommend a coder/coding auditor, ancillary services representative, and all respective Defense Medical Human Resources System – internet (DMHRSi) personnel (ie. DMHRSi Manager, contract liaison, civilian liaison, volunteer liaison, and Command Support Staff (CSS) personnel), UBO Manager, and clinic support staff representative attend meetings

45. Excellent Healthcare, Clinical Currency DQ Assurance Team Provide oversight of the provider file clean-up and maintenance, TMA coding audit, MEPRS Account Subset Definitions (ASD) reconciliation and use, DMHRSi program, DD Form 2569 collection process, and any other DQ issues. Develop DQ initiatives Communication, ensure there is cross-talk. Recommend at your next DQ meeting, that everyone goes around the room and understands why they are a member of the team, what role they have in DQ, and what ideas they have to make the team (ultimately your MTF) better.

46. Excellent Healthcare, Clinical Currency DQ Assurance Team Initiatives - 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 45

47. Excellent Healthcare, Clinical Currency 46 DQ Assurance Team Initiatives - Interest Items (cont) Patient safety CHCS Training Accountability Improve data accuracy Include critical data elements Correct critical data elements Capture workload and revenue opportunities

48. Excellent Healthcare, Clinical Currency 47 Provider File Correction Process Central DSS Provider File pull with a focus on recent activity 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”

49. Excellent Healthcare, Clinical Currency 48 CHCS Provider File Report Cards

50. Excellent Healthcare, Clinical Currency 49 Provider Details Report

51. Excellent Healthcare, Clinical Currency 50 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

52. Excellent Healthcare, Clinical Currency CHCS Provider File Errors and Error Criteria (example) 51

53. Excellent Healthcare, Clinical Currency 52 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 Error correction and prevention

54. Excellent Healthcare, Clinical Currency 53 Outside Provider Entry Checklist

55. Excellent Healthcare, Clinical Currency 54 Provider File Progress Chart Provider File Progress Chart can be found at: https://vc.afms.mil/AFMOA/SGA/SGAR/SGARDQ/Documents/Forms/AllItems.aspx https://vc.afms.mil/AFMOA/SGA/SGAR/SGARDQ/Documents/Forms/AllItems.aspx Click Performance Measures ( Metrics) then Provider File Progress Charts The Provider File Progress Chart is based on a Microsoft Excel pivot table. This particular chart reflects the percentage of entries with errors. This information was taken directly from the provider report cards that were generated for each site since Nov 2009. Within the chart you can filter on the one or a combination of the following fields in order narrow the criteria to just your facility or to compare your facility with others. Facility Type (Peer Group) MAJCOM Base Data Month (Report Month)

56. Excellent Healthcare, Clinical Currency 55 Provider File Progress Chart

57. Excellent Healthcare, Clinical Currency Facility Type Filtering 56 To filter one Facility Type (peer group) click the arrow and select the facility type you want to view. This will automatically update the chart. **NOTE** To select more than one type check the “Select Multiple Items” box. Uncheck (ALL) then check the Types you wish to view.

58. Excellent Healthcare, Clinical Currency MAJCOM Filtering 57 To filter one MAJCOM click the arrow and select the MAJCOM you want to view. You can filter on this field only or within another filter, (small clinic is shown in this example). This will automatically update the chart. **NOTE** To select more than one MAJCOM check the “Select Multiple Items” box. Uncheck (ALL) then check the MAJCOMs you wish to view.

59. Excellent Healthcare, Clinical Currency Base Filtering 58 To filter one or multiple bases, click the arrow and select the bases you want to view. Uncheck (Select All), then check the bases you wish to view. NOTE: All Bases are shown in the pick list. However be aware if you are using multiple filters, your selected clinic must fall into the same category as those filters or it will not appear on your chart. EXAMPLE: Shown there is a filter on Facility type of Small Clinic and a filter on MAJCOM of AETC. If you now select Shaw as your base the chart would be blank because Shaw is a Small Clinic but falls under the MAJCOM of ACC not AETC.

60. Excellent Healthcare, Clinical Currency 59 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 AFMOA UFR to centrally procure HCIdea website subscription for MTFs to support their correction efforts, $50K annually

61. Excellent Healthcare, Clinical Currency Current Data Quality Efforts 60 AFMOAAMCAFMSADHIMSMHS Function:Comprehensive CHCS Clean-up CHCS Patient File Clean-up - SME Support - Training Auto Merge Duplicate Patient CHCS/AHLTA using COTS Enterprise Wide Scheduling & Registration Sys Role:ID/Facilitate/PreventID/Fix/Prevent Prevent Contractor:PSI (prime) Smartronix/Evolvent (subs) Smartronix SAIC Issues:- 2 FTEs - Executed final option year – ends 28 SEP 11 - Flexible - 4 FTEs - Exp 15 DEC 10, +1 option yr - Linked Functionally to AFMSA Contract - 10 FTEs onsite + - 1-yr, ends 27 SEP 10, 6-mo extension working - Revisit FY12 POM grade/$ -1 yr - Eliminate dup patient backlog - Design/build/test - Behind Schedule - System deployment may be at risk Proposal:- Continue to develop & mature - Tackle all K requirements - Consolidate with AFMOA DQ K - Reprogram $ from AMC to AFMOA - Transition to AFMOA oversight if funding provided - Support as AF Functional Rep - Ensure AF efforts complement - Continue to monitor and adjust efforts accordingly All CHCS Files Patient File Related

62. Excellent Healthcare, Clinical Currency Patient Registration DQ Team

63. Excellent Healthcare, Clinical Currency Patient Registration DQ Team (cont)

64. Excellent Healthcare, Clinical Currency Patient Registration DQ Team (cont)

65. Excellent Healthcare, Clinical Currency Automating Duplicate Patient Merge (ADPM) Initiative

66. Excellent Healthcare, Clinical Currency 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 Reminders

67. Excellent Healthcare, Clinical Currency DQ Review List/Statement Reminders The due date is NLT the 25 th of the month. If the 25 th 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 20 th of each month but now is due approximately on the 15 th of each month The auditors still have over a month to complete the audit Timeliness and Accuracy Metric

68. Excellent Healthcare, Clinical Currency

69. 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 and yellow and if 3c or 3d is under 100% 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/Statement Comments

70. Excellent Healthcare, Clinical Currency 69 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

71. Excellent Healthcare, Clinical Currency 70 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

72. Excellent Healthcare, Clinical Currency DQ Review List Software Version Question B.2. List the current version of software being used? Most recent version released MTF software version used c) CCE Source is Systems Office “If using recent version” = Green “If not using recent version or software version not listed” = Red (comments required) N/A; can only be used if CCE is not deployed at your MTF d) CHCS Source is Systems Office “If using recent version” = Green “If not using recent version or software version not listed” = Red (comments required) N/A; not appropriate for this question 71

73. Excellent Healthcare, Clinical Currency 72 EOD AND ADM Compliance Procedures AHLTA Exception Report Delinquent End-Of-Day Clinic Reporting Monitoring Compliance in BDQAS Appointments with No ADM Records By Clinic Report ADM SADR/CAPER Error Report NOTE: Training Materials are posted on Vector Check to assist with your compliance

74. Excellent Healthcare, Clinical Currency DQ Review List Rejected Data Question B.4. Were all rejected data corrected and retransmitted? (As applicable.) a) ADM Source is DQ Manager “Yes” = Green “No” = Red (comments required) N/A; Only use if you did not have any rejected data needed to be corrected or retransmitted. b) AHLTA Source is AHLTA Administrator “Yes” = Green “No” = Red (comments required) N/A; Only use if you did not have any rejected data needed to be corrected or retransmitted. 73

75. Excellent Healthcare, Clinical Currency AHLTA ADM Exceptions Report Overview of Report The AHLTA Ambulatory Data Module (ADM) Exceptions Report is an on-demand, report from the AHLTA Local Cache Server (LCS) It displays transactions that failed to write the encounter data for completed (signed) encounters from AHLTA into CHCS/ADM. 74

76. Excellent Healthcare, Clinical Currency 75 DQ Review List/Statement Completeness 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

77. Excellent Healthcare, Clinical Currency DQ Review List/Statement BDQAS https://bdqas.afms.mil 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 20 th 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 Coding questions are typically updated around the 20 th but they made need to be provided by auditor

78. Excellent Healthcare, Clinical Currency What is BDQAS? The Biometric Data Quality Assurance Service (BDQAS) was developed to monitor the timeliness and completeness of the: Standard Ambulatory Data Record (SADR) Standard Inpatient Data Record (SIDR) Worldwide Workload Report (WWR) BDQAS metrics objectively demonstrate the performance of the MTFs and MAJCOMs in submission of timely and complete data BDQAS metrics identify potential problem areas that require leadership action 77

79. Excellent Healthcare, Clinical Currency BDQAS Contents 78 More than collecting answers for the DQMC Review List/Statement Inpatient Metrics Clinical Coding Reports DQ Reports WWR Metrics CHCS Ad Hoc Samples Timeliness metrics (MTF rankings) Completion metrics (MTF rankings) Open encounters by month and FY FY11 code release could have potentially created broken encounters

80. Excellent Healthcare, Clinical Currency BDQAS Benefits How is this data useful to me as a DQ Manager? A useful tool in identifying the clinics that are non-compliant in timeliness and completeness of SADRs Prompts staff to run required reports to prevent non- compliance stats being reported on BDQAS Appointments with No ADM Records by Clinic Opportunity to improve your percentages reported on the DQMC Review List and Statement 79

81. Excellent Healthcare, Clinical Currency Select Data Metrics

82. Excellent Healthcare, Clinical Currency Select Data Quality Statement Reports

83. Excellent Healthcare, Clinical Currency Select the command for your MTF

84. Excellent Healthcare, Clinical Currency Select your MTF and then the data month These are the questions and percentages for each question BDQAS pulls Note: Manual procedures in DQ TUG if needed

85. Excellent Healthcare, Clinical Currency 84 DQ Review List/Statement Timeliness 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

86. Excellent Healthcare, Clinical Currency 85 DQ Review List/Statement Validation 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

87. Excellent Healthcare, Clinical Currency DQ Review List/Statement MEWACS 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 16 th 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

88. Excellent Healthcare, Clinical Currency Click on MEWACS and then MEWACS Online

89. Excellent Healthcare, Clinical Currency Click on Click here to launch MEWACS Online!

90. Excellent Healthcare, Clinical Currency Select Data Load Status, then Summary Outliers, then WWR/EAS IV Outliers, and then Allocation Test

91. Excellent Healthcare, Clinical Currency Data Load Status

92. Excellent Healthcare, Clinical Currency Summary Outliers

93. Excellent Healthcare, Clinical Currency WWR/EAS IV

94. Excellent Healthcare, Clinical Currency Allocation Test

95. Excellent Healthcare, Clinical Currency 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 94 AFMOA MEPRS Dashboard

96. Excellent Healthcare, Clinical Currency 95 AFMOA MEPRS Dashboard Nellis AFB, Nov 2009 Validated Error Errors Research

97. Excellent Healthcare, Clinical Currency 96 AFMOA MEPRS Dashboard Nellis AFB, Apr 2010 Research Corrections Pending Corrected Validated Research

98. Excellent Healthcare, Clinical Currency 97 DQ Review List/Statement Validation and Reconciliation Question C.1.e. & f. (DQ Statement question 3.c) 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

99. Excellent Healthcare, Clinical Currency 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

100. Excellent Healthcare, Clinical Currency 99 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

101. Excellent Healthcare, Clinical Currency 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 100

102. Excellent Healthcare, Clinical Currency 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 101 Patient Duplicate Reporting

103. Excellent Healthcare, Clinical Currency 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 102 Patient Duplicate Reporting

104. Excellent Healthcare, Clinical Currency 103 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 (5 th Duty Day of the month) Source is BDQAS C.3.c. (DQ Statement question 4.c.) WWR/CHCS (5 th Duty Day of the 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

105. Excellent Healthcare, Clinical Currency 104 DQ Review List ADM SADR/CAPER Errors Question C.4. Were the following activities performed? a) Check the ADM SADR/CAPER Error Report? b) Correct the errors listed on the report? Source is DQ Manager “Yes” = Green “No” = Red (comments required) N/A; not appropriate for these questions

106. Excellent Healthcare, Clinical Currency 105 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

107. Excellent Healthcare, Clinical Currency DQ Review List/Statement Availability Question C.8. In a random review of Non-Active Duty medical records/encounters from the data month, looking for the DD Form 2569s (electronic or hardcopy), the UBO staff determined the following percentages for each type of record Inpatient, Outpatient, and APVs: a, c, e) (DQ Statement questions 8a (Inpatient), 8c (Outpatient), 8e (APVs)) What percentage of completed and current (signed within the past 12 months) DD Forms 2569 (TPC Insurance Info) are available for audit? Source is UBO Manager Number of Complete and Current DD Form 2569s Available Number of Non-Active Duty APV Records available from Audit > 95% = Green > 80% < 95% = Yellow < 80% = Red Comments required for Yellow and Red percentages N/A; C.8.a) Only if outpatient facility; C.8.c) not appropriate for this questions; C.8.e) If outpatient facility with the exception of Academy and Incirlik 106

108. Excellent Healthcare, Clinical Currency DQ Review List/Statement Accuracy Question C.8. In a random review of Non-Active Duty medical records/encounters from the data month, looking for the DD Form 2569s (electronic or hardcopy), the UBO staff determined the following percentages for each type of record Inpatient, Outpatient, and APVs: b, d, f) (DQ Statement questions 8b (Inpatient), 8d (Outpatient), 8f (APVs)) What percentage of available, current, and complete DD Form 2569s is verified to be correct in the PII module in CHCS? Source is UBO Manager Number of Correct Entries in the PII Module Number of Available, Current, and Complete DD Form 2569s > 95% = Green > 80% < 95% = Yellow < 80% = Red Comments required for Yellow and Red percentages N/A; C.8.b) Only if outpatient facility; C.8.d) not appropriate for this question; C.8.f) If outpatient facility with the exception of Academy or OCONUS bases with the exception of Elmendorf 107

109. Excellent Healthcare, Clinical Currency 2569 DQ Review List/Statement Questions C.8.c. What percentage of completed and current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) is available for audit (non- active duty encounters only)? Number of complete and Current DD Form 2569s Available 95 100 Number of Non-Active Duty Non-APV Records Available from Audit Searching for a patients 2569 information in Mini Registration is incorrect and should not be used to conduct the audit C.8.d. What percentage of available, current and complete DD Form 2569s is verified to be correct in the Patient Insurance Information (PII) module in CHCS? Number of DD Form 2569s Correct in PII Module in CHCS 93 95 Number of Available, Current and Complete Non Active Duty DD Form 2569s available from the Outpatient – Non APV 2569 Audit The numerator in C.8.c. becomes your denominator in question C.8.d.

110. Excellent Healthcare, Clinical Currency DQ Review List/Statement Completeness Question C.9. Comparison of reported workload data. a) (DQ Statement question 9a) # SADR Encounters (count only) / # WWR visits N/A; not appropriate for this question b) (DQ Statement question 9b) # SIDR Dispositions / # WWR Dispositions N/A; Only if outpatient facility c) (DQ Statement question 9c) # EAS Visits / # WWR Visits N/A; not appropriate for this question d) (DQ Statement question 9d) # EAS Dispositions / # WWR Dispositions N/A; Only if outpatient facility Source is BDQAS > 95% = Green > 80% < 95% = Yellow < 80% = Red Comments required for Yellow and Red percentages 109

111. Excellent Healthcare, Clinical Currency DQ Review List/Statement Completeness Question C.9. Comparison of reported workload data. e) (DQ Statement question 9e) # of A*** SADRs that were completed by the attending provider/service (FCC=A***)/Number of Sum WWR (Bed Days + Bassinet Days + Dispositions) Source is M2 and WWR (Internal Process) > 80% = Green < 80% = Red (comments required) 110

112. Excellent Healthcare, Clinical Currency DQ Review List/Statement AHLTA Use Question E.4.i. Was a process in place, such as System Incident Report, where users can identify issues affecting system functioning and operations? a) (DQ Statement question 10) Number of AHLTA SADR encounters/Number of Total SADR encounters (ALL SADR encounters including Immediate Care, Observations, APVs and ER) 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. Source is BDQAS > 95% = Green > 80% < 95% = Yellow < 80% = Red Comments required for Yellow and Red percentages 111

113. Excellent Healthcare, Clinical Currency DQ Review List Contingency Plans Question E.6. Are there contingency plans in place to restore operations for Business Operations and System Operations? a) ADM - N/A b) AHLTA - N/A; Not appropriate for this question c) CCE - N/A for Business Operations; N/A; only if CCE is not deployed at your facility for System Operations d) CHCS - N/A; Not appropriate for this question e) DMHRSi - N/A; Not appropriate for Business Operations; N/A for System Operations f) Essentris - N/A; If outpatient facility or Essentris is not deployed yet g) MEPRS - N/A; Not appropriate for Business Operations; N/A; for System Operations h) TPOCS - N/A; Only if OCONUS w/exception of Hickam, Eielson, Elmendorf Source for System Operations is Systems Source for Business Operations is Managers using program “Yes” = Green “No” = Red (comments required) 112

114. Excellent Healthcare, Clinical Currency DQ Review Referred to Network Question E.8. TRICARE Managed Care use. a) For the data month, how many patients, enrolled to the MTF, were referred to the network for care? Source is TOPA personnel # Entered = Green # not Entered = Red (comments required) N/A; not appropriate for this question 113

115. Excellent Healthcare, Clinical Currency DQ Statement Awareness Question 12. I am aware of the data quality issues identified by the completed Data Quality Statement and Data Quality Management Control 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 114

116. Excellent Healthcare, Clinical Currency 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 Will be housed on Vector Check 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 Electronic DQ (eDQ) Review List and Statement

117. Excellent Healthcare, Clinical Currency eDQ Access via Vector Check

118. Excellent Healthcare, Clinical Currency eDQ Review List Main Page

119. Excellent Healthcare, Clinical Currency eDQ Review List Sample View

120. Excellent Healthcare, Clinical Currency eDQ Rejection Sample

121. Excellent Healthcare, Clinical Currency 120 AFMOA DQ Points of Contact Group Email Box: Afmoa.dq@us.af.mil Data Quality Program DirectorData Quality Analyst DSN 969-9217DSN 969-9226Data Quality Analyst DSN 969-9240DSN 969-9235

122. Excellent Healthcare, Clinical Currency 121 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

123. Excellent Healthcare, Clinical Currency 122 Useful Web Sites Data Quality http://www.tricare.mil/ocfo/mcfs/dqmcp/management_control.cfm BDQAS - https://bdqas.afms.mil 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/

124. Excellent Healthcare, Clinical Currency 123 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

125. Excellent Healthcare, Clinical Currency 124 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

126. Excellent Healthcare, Clinical Currency 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 125

127. Excellent Healthcare, Clinical Currency 126 Data Quality Program Office Questions? Data Quality Umbrella Data Quality Foundation

128. Excellent Healthcare, Clinical Currency CHCS Provider File Errors and Error Criteria (cont) 127