2010 UBO/UBU Conference 1 Title: MEPRS Panel: Internal Management Controls Speakers: Mona Bacon, Darrell Dorrian, Colleen Rees, Patrick Wesley Session: T

Objectives Define Internal Management Controls (IMC) Illustrate how Internal Management Controls are implemented through inputs, processes, and outputs for each of the services and TMA. Describe how Internal Management Controls elevate the Data Quality standard. 2

Overview Definition, objectives, and authority for Internal Management Controls Inputs, Processes, and Outputs o Army o Air Force o Navy o TMA Audience participation 3

The integration of activities, plans, attitudes, policies, systems, resources and efforts of the people of an organization working together to provide reasonable assurance that the organization will achieve its objectives and mission. Definition of Internal Control 4

Effectiveness and efficiency of operations Reliability of financial reporting Compliance with applicable laws and regulations Objectives of Internal Control 5

Federal Managers' Financial Integrity Act of 1982 Purpose is to establish a framework for ongoing evaluations of agency systems for internal accounting and administrative control. Requires agencies to establish internal accounting and administrative controls in compliance with standards established by the Comptroller General. It also requires OMB to establish guidelines that the agencies shall follow in evaluating their systems of internal accounting and administrative controls. Authority for Internal Control 6

OMB Circular A-123 Defines management responsibility for internal control. Intended to strengthen requirements for conducting management assessment of internal controls over financial reporting. Emphasizes the need to integrate and coordinate internal control assessments. Authority for Internal Control 7

Control environment Communication Assessing and managing risk Control activities Monitoring Basic Components of Internal Control 8

Promotes orderly, economical, efficient and effective operations Produces quality products Promotes adherence to management directives Develops and maintains reliable financial and management data 9 Purpose of IMC

MEPRS/EAS Policy for Implementation of Data Validation and Reconciliation MEPRS Management Improvement Group (MMIG) developed data validation and reconciliation processes o Reconciliation procedures templates and workbooks 10 MEPRS and IMCs

Internal Management Controls OAP/OIP Financial Reconciliation DQ Summary Reports DMHRSi 11 Army MEPRS Program Office (AMPO) Presented by: Mona Bacon Army MEPRS Program Office(AMPO)

Operational Assessment Program of Internal Processes File and Table Maintenance Reconciliation Procedures MEPRS System and Data Backups MEPRS Staff and DQ MEPRS Processing Findings and Observations 12 Army MEPRS Program Office (AMPO)

Financial Reconciliation The purpose of the financial reconciliation is to ensure that the financial expense and obligation data reported by MTFs in MEPRS is consistent and reconciled with financial expense and obligation data reported STANFINS GFEBS on a monthly basis. There are four EASi Reports required for a financial reconciliation: Financial Pure, Personnel Pure, Personnel Accepted Report, and Direct Expense Accepted Report. Financial Reconciliation has to be completed prior to monthly transmission AMPO Financial Reconciliation Helpful Hints 13 Army MEPRS Program Office (AMPO)

Data Quality Reports DQ Summary Reports o Execute approximately 50 queries against transmitted data o Data Set Reporting o Adherence to MTF Data Set Guidelines and Business Rules o Unallocated Expenses o Mismatched Personnel Records o Work Centers Not Reporting Workload AMPO Discrepancy Reports o Ambulatory Workload with Zero/Negative Expense o Inpatient Workload with Zero/Negative Expense o Zero Ambulatory Workload with Expense o Zero Inpatient Workload with Expense 14 Army MEPRS Program Office (AMPO)

DMHRSi DMHRSi Timecard Compliance Metric o Pulled the 16 th day after the pay period ends Inpatient Nursing Staff o Developed a specific Nursing template  Data is being used to identify their manpower requirements Nursing Tracking absentee rates for civilian and military WRMC Rapid Experiment o Standardized PM DMHRSi Timesheet o Administrative Governance Metric DENCOM imports personnel data from DMHRSi into their CDA System 15 Army MEPRS Program Office (AMPO)

MODELS/METRICS Practice Management Revenue Model (PMRM) Enrollment Capacity Model (ECM) Performance Based Adjustment Model (PBAM) PPS MERHCF 16 Army MEPRS Program Office (AMPO)

Internal Management Controls MEPRS Users Guide (MUG) Personnel – DMHRSi – MEPRS Dashboard/MEWACS – End of Month Processing Guide Financial – Financial Reconciliation – MEPRS Dashboard/MEWACS 17 Air Force MEPRS Program Office Presented by: Darrell Dorrian Air Force MEPRS Program Office

Internal Management Controls (Cont.) Workload – MEPRS Dashboard MEWACS More evaluations performed during HSI inspections – 2011 Self-Inspection Checklist Formalized in AF Instruction (AFI ) 18 Air Force MEPRS Program Office

Internal Management Controls 19 Navy Medicine Presented by: Colleen Rees Bureau of Medicine and Surgery

Navy MEPRS Organizationally FOR OFFICIAL USE ONLY Echelon 4RegionsBUMED Ms. ReesNCA – Ms. Huston4 Commands NME – Ms. Jefferson 14 Commands NMW – Mr. Coppola 12 Commands NMSC – Ms. Reesey NAVMISSA Call Center EAS Training CAI –Support Mr. Van Nostrand Ms. Burchess Ms. Rehbein Ms. Meyers CAI –Support Mr. Van Nostrand Ms. Burchess Ms. Rehbein Ms. Meyers

Navy Medicine MEPRS Program FY11 Initiatives – Meet the Dead----Line – On time and right the first time – Medical Home Port Implementation 4 th Level Defines Workcenters - MHP Teams Outpatient Cost Pool MHP Only! Validation Tools – Input Source Table Validation – Output MEWACS – CCR Navy Medicine EAS Data Quality Checks 21

In conjunction with MEWACS and CCR Proper Use of 3 rd Level “Z” codes Expenses reported w/o Workload Workload w/o Direct Expenses and/or Negative Expenses Workload w/o FTEs Civilian Labor (SEEC 11.10): Expense and Obligation Reconciliation Unallocated expenses – Cost Pool Breakdown Cost Per Disposition & Visit Available to Assigned FTE Ratio 22 NAVY EAS Data Quality Checks

On the Horizon – ROLE BASED TRAINING Collaboration effort with SMEs – CRAZY EIGHT Analysis – Streamlining of 4 th level MEPRS code at core and branch clinic level 23 Navy MEPRS Program

24 TMA MEPRS Program Office Presented by: Patrick Wesley TMA MEPRS Program Office Purpose of MEPRS data at the TMA level is to provide uniform reporting by Functional Cost Code (FCC) of expense, manpower, & workload for DoD Medical Treatment Facilities (MTF) providing management a basic framework for cost and work center accounting.

25 MEPRS Data: DoD-Standardized, Aggregated by FCC  Service-specificFinancialdata  Army: STANFINS/GFEBS (Standard Army Finance System/General Fund Enterprise System)  Navy: STARS-FL (Standard Accounting and Reporting System/Field Level  Air Force: GAFS-R (General Accounting Finance System Rehost)  Personnel  DMHRSi (Defense Medical Human Resource System - internet)  Workload  CHCS / WAM (Composite Health Care System / Workload Assignment Module) TMA MEPRS Program Office

26 TMA MEPRS Program Office

27 TMA MEPRS Program Office Data Quality Statement Metrics

28 TMA MEPRS Program Office MEPRS Early Warning and Control System (MEWACS) An interactive data quality feedback tool developed by the MEPRS Management Improvement Group (MMIG) to proactively identify, investigate, and resolve MEPRS data anomalies in a timely, systematic manner. Updated monthly, MEWACS contains numerous Tri-Service MTF activity level metrics, including: EAS IV Repository data load status and compliance with 45-day reporting suspense MTF-specific summary data outliers Interactive MTF MEPRS Data Profiles Ancillary and Support expense allocation tests

29 TMA MEPRS Program Office Consolidated Cost Report An interactive Service-specific monthly MEPRS data snapshot by Military Treatment Facility, Fiscal Month, and 4th-Level Functional Cost Code. The purpose of the CCR is to expedite data quality evaluation, expense and workload validation, and MEPRS data management by providing detailed monthly expense data at the intermediate account level.

30 TMA MEPRS Program Office Six Sigma MEPRS Management Metrics (S2M3) Six Sigma is a highly disciplined process focusing on development and delivery of near-perfect products and services. Applying Six Sigma principles in the MHS can lead to continued improvements in data quality and financial management. As a benchmarking tool, Six Sigma metrics can be used to map MTF performance against a group of cohorts or peers - quantifying opportunities for improvement. These metrics offer a snap shot of the Direct Care operation at MTFs, including staffing, financial, and workload. By arraying the data in peer groups, MTFs can see their rank in the cohort relative to similar facilities.

31 TMA MEPRS Program Office MEPRS Data Applications MEPRS data are routinely used by TMA, Services and MTFs for policy and management decisions. Typical MHS-level applications include: MHS Efficiency & Valuation metrics Medicare Eligible Retirees Healthcare Fund (previously TRICARE for Life (TFL) Accrual Fund) Inpatient Third Party Collection Rates (Adjusted Standardized Amounts) BRAC, Realignment, and Optimization Studies Congressional Inquiries

32 Summary Internal Management Controls are implemented at all levels of the MHS. At each stage of inputs, processes, and outputs there are policies and programs in place to promote data quality. MEPRS data are utilized internally to the MHS as well as externally for decision making and problem solving.

33 Q&A Questions?