TMA DQ Course AF Break-Out Session AFMOA/SGAR 4 MAR 10

TMA DQ Course AF Break-Out Session - Overview Organization MTF Engagement DQ Program Best Practices CHCS Provider File Improvement Efforts Other DQ Initiatives Specific Training Optional Training DQ POCs Important References Useful Website

Organization HAF/SG8Y (policy) AFMOA (execution) Chief, Resource Operations Program Manager AF MEPRS Program Manager Program Analyst Acting AF DQ Manager DQ Subject Matter Expert

MTF DQ Engagement One-on-one support Telephone E-mail: afmoa.dq@lackland.af.mil Defense Connect Online (DCO) MTF-AMFOA DQ Telecons every other month PACAF, CONUS, USAFE Business and training conducted Schedule for CY10 on Vector Check DCO is the primary tool used to conduct meetings and take attendance Serving/supporting our MTFs occupies a large portion of our time also. Attempt to research, then if you need assistance let us know.

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

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.

MTF DQ Engagement (continued…) AF portion of the TMA DQ Course Other training/interaction forums: Annual RMO, UBO/UBU Conferences, etc…. Staff Assistance 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 SAVS: new personnel, preparing for an inspection, simply want to take a good program and make it better, or new cc simply want a baseline

MTF DQ Engagement (continued…) 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 and 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\

TMA DQ Course AF Break-Out Session Why is DQ Important? Revenue Cycle DQ System Architecture How is Your Data Used Success Factors HSI Requirements DQ Toolkit…a.k.a. Vector Check DQ Assurance Team DQ Review List DQ Statement

Why is Data Quality Important? To accurately reflect the work performed in your MTF

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

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

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

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

HSI Requirements Data Quality Manager appointment letter Commander’s DQ Statements (previous 12 months) DQ Assurance Team meeting minutes (previous 2 years). The MTF/CC appointed a DQ Manager who is responsible for accomplishing Data Quality Management Control (DQMC) activities Completes the DQMC Review List and briefs results to the MTF Executive Committee A DQ Assurance Team was established (or an existing structure was tasked) 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, and GPMs MEPRS data was reconciled and validated prior to entry into EAS First 3 items are from the H S I Document Pull List The rest is exactly what the H S I Checklist states regarding DQ

DQ Toolkit…a.k.a. Vector Check “Think of Vector Check as your DQ Toolkit” – key components in your toolkit: Data Quality Manager’s User Guide (DQ MUG) 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 Let me take a minute to talk about the MUG and the Workload Guidelines. We’ll talk more about the CHCS Provider File Continuity Guide later when we discuss the Provider File Report Cards.

DQ MUG Primary AF Specific DQ Guidance DQ Statement clarification Formulas/background info/how to get the data Share MUG with your entire DQ team (TUG vs. MUG) Discuss MUG at your DQ meeting to ensure it is read and understood by those answering DQ Statement questions Living document...updated during the year as needed Published by HAF DQ DQ MUG Sample:

DQ MUG Format 8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions? 8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions? Performance Threshold: Greater than or equal to 95%; GREEN Greater than or equal to 80% but less than 95%; YELLOW Less than 80%; RED The Air Force Standard for this metric is 95% or greater. Calculation: EAS Total Dispositions ----------------------------------- WWR Total Dispositions Details: This question is only applicable to facilities with inpatient services. This is the ratio of EAS IV inpatient visits to the inpatient dispositions reported in the WWR. The EAS IV dispositions and visits are the numbers submitted by the MTF as of the suspense date and are downloaded from the AMPO repository. Please check with your RM or MEPRS staff to validate the information. If your MTF have submitted a corrected EAS IV or have made a late transmission, let BDQAS staff know to refresh the data and update their files. Insure corrections made in one data system are also made in the others. Process: Recommended process is to go to the BDQAS web site at: https://bdqas.brooks.af.mil/data_metrics/data_metrics.htm Go to Data Quality Reports-Data Quality Statement Reports. Find your Major Command, then your Facility and then the correct reporting month. Find the monthly percentage for Question 8d. https://kx.afms.mil/kxweb/dotmil/file/web/ctb_117012.pdf

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*** Count Registered dieticians or licensed nutrition Professionals are responsible for providing medical nutrition therapy (MNT). Yes Supplements AF Coding Guidelines Published by AF Coding Experts https://kx.afms.mil/kxweb/dotmil/file/web/ctb_098772.pdf

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, and Group Practice Managers Although not a requirement, recommend a coder/coding auditor, ancillary services representative, and clinic support staff representative attend meetings Provide oversight of the provider file clean-up and maintenance Develop DQ initiatives

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

DQ Assurance Team Improvement Opportunities Patient safety CHCS Training Accountability Billing Improve data accuracy Include critical data elements Correct critical data elements Capture workload and revenue opportunities

Data Quality Review List Refining/expanding beyond DQ statement 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

Data Quality Statement DQ Statement Reminders Comments BDQAS MEWACS Electronic DQ (eDQ) Review List and Statement We will not rehash the DQ Statement since we went over that earlier today in the big session; however, there are certain AF Specific things we need to discuss.

Data Quality Statement Reminders The due date is NLT the 25th of the month. If the 25th falls on a weekend, please have statement submitted the Friday prior Submitted Spreadsheet to AFMOA should match exactly what the CC signed DQMC Statement is required to have all supporting summary documentation kept on file for five years The coding audit due dates will change effective April. The audit previous was due approximately the 20th of each month but now will be due approximately the 15th of each month The auditors will still have over a month to complete the audit MTFs need back up plans for Data Quality and all other areas that support answering the Statement.

DQ Statement Comments 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 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) Even if using the same comment from another question, please use the entire comment for each question. Get to know the questions on the DQ Statement

DQ Statement Comments (continued…) Question 1a, comments are required if yellow or red Question 3c and 3d, comments are required if under 100% Question 3d 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 3c 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.

DQ Statement BDQAS https://bdqas.brooks.af.mil/index2.htm 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 20th

BDQAS Select Data Metrics Share MUG with your entire DQ team

Select Data Quality Statement Reports

Select the command for your MTF

Select the command for your MTF

Note: Manual procedures in DQ MUG if needed Select your MTF and then the data month These are the questions and percentages for each question BDQAS pulls Note: Manual procedures in DQ MUG if needed

DQ 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 16th 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 Download the MEWACS Excel file for the Review Month from the MEWACS web site at http://www.meprs.info/mewacsxls.cfm

User guide is very helpful step by step tool User guide is very helpful step by step tool. Also you can download an excel file of you MEWACS info. Click here

Data Load Status Summary Outliers WWR/EAS IV Allocation Test

Data Load Status

Summary Outliers

WWR/EAS IV

Allocation Test

Electronic DQ (eDQ) Review List and Statement 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 Development originally linked to Vector Check design/deployment Stalled for a variety of reasons: differing corporate memory; funding/EOY; evolving requirement request processes Way Ahead (No firm ECD, but it’s coming): Prototype almost complete Verbal commitment from AFMOA leadership to fund completion Deploy at test sites/collect feedback…adjust…deploy AF-wide Design/implement performance metrics

Best Practices Current Best Practices Posted on Vector Check FY 10 DQMC Review List in Excel Format Sample DQ Agenda Sample DQ 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

CHCS Provider File Background 584,000+ provider file records across the AF 37,500 new provider file records created each year since 2001 Average MTF error rate is 46.36% (Not all errors are equal, some are administrative, while others are show stoppers (possibly affect patient safety and reimbursements) Initial central correction efforts began at SG8Y Each MTF ran provider file pulls and sent them to SG8Y Manual analysis of provider file errors conducted Site Analysis Reports (SAR) produced for each MTF Cumbersome (7+ page word document/problems embedded) Lack of performance metrics Inconsistent Follow-up Scope and impact of this problem required a new approach Ripe for omission/error in targeting improvement opportunities Too much time dedicated to error/discrepancy identification vs. supporting the MTF in correcting problems

New and Improved Provider File Correction Process Central DSS Provider File pull with a focus on last 2.5 yrs of activity (1 APR 07 to Today) 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” Automation supports timely information distribution and enhanced AFMOA support Establishes baseline performance measures Capture missed reimbursement OHI/TPC opportunities Improve CHCS DQ…reduce rework, potentially improve patient safety

CHCS Provider File Errors CHCS Provider File fields analyzed for errors Naming Convention NPI- Null NPI – Duplicate Signature Class/Provider Specialty Code (PSC) mismatch Signature Class PSC HIPAA Taxonomy Primary Hospital Location DEA/License # Generic Provider Potential Duplicates

Error Criteria

Error Criteria (continued…)

Impacts to Provider File Errors What are the potential impacts of incorrect or null data in the CHCS provider file? Patient Safety Revenue Workload Data Integrity

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 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, 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

MTF Report Cards Automatically generated from the MTF detail file Baseline MTF CHCS provider file metrics Shows types of errors/discrepancies Shows the primary effect/impact Focused two-page format More readable and actionable Includes performance measures (peer-group based) Error rates for each MTF/DMIS captured Monthly trend analysis of new provider entries Other statistical information captured for future comparison AFMOA DQ Follow-up ingrained in the process

Provider Report Card (continued – page 2)

Provider Details Report Error ID on the left; scroll to the right to view the actual field – what is actually in CHCS. Some fields are linked (ref Cont Guide).

AFMOA DQ Provider File Roles/Responsibilities

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

MTF DQ Team Provider File Roles/Responsibilities

Provider File Way Ahead Active ongoing support of MTF improvement efforts Further refine approach based on MTF feedback Enhance tool documentation Increase reporting frequency (monthly vs. quarterly) Share reports with MTF Leadership in APR 10 Improvement progress tracked on Vector Check Partner w/HAF to centrally procure HCIdea website subscription for MTFs to support their correction efforts, $50K annually Optimize TPC dollars Maximize Patient Safety Eliminate potential legal ramifications

Other Data Quality Efforts AFMOA AMC AFMSA DHIMS Function: Comprehensive CHCS Clean-up CHCS Patient File Clean-up SME Support Training Auto Merge Duplicate Patient CHCS/AHLTA using COTS Role: ID/Facilitate/Prevent ID/Fix/Prevent ID /Fix/Prevent Contractor: PSI (prime) Smartronix (sub) Smartronix SAIC Issues: 2 FTEs 1 yr + 1 Flexible 4 FTEs Exp 15 DEC 10, +1 option yr Linked Functionally to AFMSA Contract 10 FTEs onsite + 1-yr Not in the POM AFMSA planned for space in 171 1 yr Eliminate dup patient backlog Design/build/test All CHCS Files Patient File Related

Patient Registration DQ Team (continued…)

Patient Registration DQ Team (continued…)

Patient Registration DQ Team (continued…)

Patient Registration DQ Team (continued…)

Patient Registration DQ Team (continued…)

Automating Duplicate Patient Merge (ADPM)

Automating Duplicate Patient Merge (ADPM) (cont)

Automating Duplicate Patient Merge (ADPM) (cont)

Automating Duplicate Patient Merge (ADPM) (cont) Theater Medical Data Store (TMDS) AHLTA/CDR CHCS

Automating Duplicate Patient Merge (ADPM) (cont)

Specific Training EOD processing Potential Duplicate Patients NPIs

Optional Training Needs of the class

DQ Points of Contact Group Email Box: Afmoa.dq@lackland.af.mil Data Quality Program Director Data Quality Analyst Data Quality Analyst Data Quality Analyst

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 These are recourses you should be familiar with, if not you can download them from the web.

Useful Web Sites Data Quality http://www.tricare.mil/ocfo/mcfs/dqmcp/management_control.cfm BDQAS - https://bdqas.brooks.af.mil/index2.htm 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/

Useful Web Sites (continued) 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

TMA DQ Course AF Break-Out Session Summary Organization MTF Engagement DQ Program Best Practices CHCS Provider File Improvement Efforts Other DQ Initiatives Specific Training Optional Training DQ POCs Important References Useful Websites

Take Aways DQ is not just the DQ statement Data needs to be accurate, complete and timely Front-end processes are CRITICAL to back-end success Culture Comments….here (i.e. read/research/back-up plans/engaged)

Data Quality Program Office Data Quality Umbrella MTF Questions? Data Quality Foundation

Data Quality Program Office ~ Backup Slides ~

Data Quality Statement Completeness Question 1. 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 Completeness of End of day Recommend a MGI for end of day processing Every clinic must ensure that every appointment is entered into the Composite Health Care System (CHCS) and closed out by midnight, the day of the appointment. Twenty-four hour clinics (i.e. Emergency Room) are the only exception; they must close all appointments of the preceding day no later than 0700 the following day. All appointments in CHCS must be closed out as soon as possible to facilitate the correct capture of workload. The Expense Assignment System (EAS) will only include appointments that have been KEPT and have a Workload Type of COUNT. Therefore the MEPRS Statistical Report (MSR), which is a monthly report that cannot be generated until ALL appointments have been closed. The World Wide Workload (WWR) report will generate but a message will display indicating appointments have not all been closed. Provide in-service education for all clinic staff personnel on the correct process for creating appointments and the procedure for placing appointments in a kept status. All clinic staff personnel must be trained to perform EOD procedures. Lack of trained personnel to perform EOD processing is not an acceptable reason for non-compliance. The clinics involved in this metric are the “B***” and “FBN*” MEPRS. This requirement excludes “A” MEPRS for Inpatient Professional Services Rounds (IPSR).   The Data Quality Manager will monitor EOD compliance by running the delinquent end of day report at the close of the business day (2300 or set to an appropriate time for your MTF) for the current days appointments (CHCS path from Scheduling Supervisor Menu>MGRM>PMGR>#1 Delinquent End of Day Processing Report). Provide feedback to clinics for compliance of EOD. Evaluate your MTF’s business processes for improvement opportunities.

Data Quality Statement Timeliness 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, has been coded within 3 business days of the encounter? Source is BDQAS b) What percentage of APVs have been coded within 15 days of the encounter? Source is BDQAS c) What percentage of Inpatient records have been coded within 30 days after discharge? Source, run inpatient timeliness adhoc found on BDQAS Question 2 a-c is coding Timeliness 2a: DoD Instruction 6040.42, 10 June 2004, Medical Encounter and Coding at Military Treatment Facilities, requires that 100% of outpatient encounters other than Ambulatory Procedure Visits (APVs) be coded within three business days of the encounter. This metric is an approximation to the question "what percentages of records were completed within three business days". The metric is normally updated three times daily (approximately 0630, 1130 and 1830 CST). This calculation does not include T-Cons nor Non-Count Encounters. These daily point-in-time snapshots are always based on the latest snapshot, so each site will get the best possible percentage. For example, if your SADR file missed the cutoff for the morning and your metric showed 90%, but the evening run included the file and your metric rose to 94%, it will be the 94% that goes into the "permanent" snapshot. The overall "weighted average percentage" is calculated by summing up all the SADR and dividing by all the DOWR (Daily Outpatient Workload Report) records. Because of the floating windows, the total SADR and DOWR will exceed the actual SADR and DOWR.   A local process will be developed to monitor clinics for incomplete records, such as running the ADM compliance report at the end of each day (CHCS path ADS>#2-Ambulatory Data Reports>#3-ADM Compliance Report). Provide feedback to providers, coders, and their supervisors. Evaluate your MTF’s business processes for improvement opportunities. The Data Quality Manager will perform this function weekly. 2b: This question is only applicable to facilities with ambulatory surgical services. DOD Instruction 6040.42, 10 June 2004, Medical Encounter and Coding at Military Treatment Facilities, requires that 100% of Ambulatory Procedure Visits (APVs) be coded within fifteen calendar days of the encounter. This metric is an approximation to the question "what percentages of records were completed within fifteen calendar days". The metric is normally updated three times daily (approximately 0630, 1130 and 1830 CST). This calculation does not include T-Cons nor Non-Count Encounters. These daily point-in-time snapshots are always based on the latest snapshot, so each site will get the best possible percentage. For example, if your SADR file missed the cutoff for the morning and your metric showed 90%, but the evening run included the file and your metric rose to 94%, it will be the 94% that goes into the "permanent" snapshot. The overall "weighted average percentage" is calculated by summing up all the SADR and dividing by all the DOWR (Daily Outpatient Workload Report) records. Because of the floating windows, the total SADR and DOWR will exceed the actual SADR and DOWR. 2c: This question is only applicable to facilities with inpatient services. DOD Instruction 6040.42, 10 June 2004: Medical Encounter and Coding at Military Treatment Facilities requires that a 100% of all inpatient records must be coded within 30 days after discharge.

Data Quality Statement Validation and Reconciliation Question 3. 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. a) Was monthly MEPRS/EAS financial reconciliation process completed, validated and approved prior to monthly MEPRS transmission? Source is MEPRS Manager and RMO Office 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? Source is MEPRS Manager MEPRS/EAS financial reconciliation process can be completed even if MTF does not transmit on-time. Big brother is watching you… TMA reviews MEWACS hits by IP addresses 3a: In accordance with AFI 41-102, “Medical Expense and Performance Reporting System (MEPRS) for Fixed Military Medical and Dental Treatment Facilities” (dated March 2008) and DoD 6010.13-M (dated April 2008), MEPRS/EAS financial reconciliation must be completed, validated, and approved prior to every monthly MEPRS transmission. The reconciliation must be completed within 45 days of the end of each fiscal month in order to meet the MEPRS submission suspense.   NOTE: This process will be performed prior to transmission but can be answered on the Statement even if you were unable to transmit data due to other reasons. 3b: In accordance with AFI 41-102, “Medical Expense and Performance Reporting System (MEPRS) for Fixed Military Medical and Dental Treatment Facilities” (dated March 2008) and DoD 6010.13-M (dated April 2008), paragraph C3.3.4, MEPRS/EAS anomalies must be addressed. The MEPRS Early Warning and Control System (MEWACS) web site is an interactive data quality feedback tool developed by the Tri-Service MEPRS Management Improvement Group (MMIG) to proactively identify, investigate, and resolve MEPRS data anomalies in a timely, systematic manner. NOTE: Review the current MEWACS spreadsheet monthly to ensure prior outliers have been addressed or resolved, if anomalies reflect accurate data, comment appropriately. (MEWACS is normally updated approximately on the 16th of each month)

Data Quality Statement Validation and Reconciliation Question 3. Continued…New Questions on Timecards submitted by close of business the Monday after the end of the pay period 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 d) For DMHRSi, what is the percentage of approved timecards by the suspense date? Source is MEPRS Manager Number of Timecards Approved On-time New questions regarding submission and approval of timecards for DHMRSi 3c: Timecards must be submitted by COB Monday after the end of the pay period. Facility processes must be established to ensure timely reporting.   This question is strictly addressing compliance with timecards, not timeliness. We realigned the Service suspense date to match the AF Surgeon General’s Policy Letter. MTFs are expected to capture 100 percent of timecards before generating the DMHRSi output file in time to meet the 45th Day MEPRS transmission requirement. For the purpose of this question, the Service suspense date is either the 45th day after the data month or the date which 100% timecard submission is reached, whichever date is earliest. For the purpose of this question, all personnel that are producing workload for the reporting month will report timecards and be considered in the denominator, to include reservists and borrowed personnel. The numerator will include timecards in submitted, approved and rejected status. 3d: Timecards must be submitted by COB Monday after the end of the pay period and must be approved by COB Wednesday after the end of the pay period. Facility processes need to be established to ensure timely reporting This question is strictly addressing compliance with approved timecards, not timeliness. We realigned the Service suspense date to match the AF Surgeon General’s Policy Letter. MTFs are expected to capture 100 percent of timecards before generating the DMHRSi output file in time to meet the 45th day MEPRS transmission requirement. For the purpose of this metric the service suspense date is either the 45th day after the data month or the date 100% timecard approval is reached, whichever date is earliest. For the purpose of this question, all personnel that are producing workload for the reporting month will report timecards and be considered in the denominator, to include reservists and borrowed personnel. The numerator will include timecards in approved status only.

Data Quality Statement Compliance Question 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).* a) MEPRS/EAS (45 days) Source is MEPRS Manager/MEWACS b) SIDR/CHCS (5th Duty of Day of the month) Source is BDQAS c) WWR/CHCS (10th Calendar Day Following Month) Source is BDQAS d) SADR/ADM (Daily) Source is BDQAS Timely Compliance submission of data 4a: After the financial, personnel, and workload reconciliations have been completed, MEPRS data must be transmitted to the EAS IV repository no later than 45 days after the end of each fiscal month. The MEPRS Early Warning and Control System (MEWACS) web site is an interactive data quality feedback tool developed by the Tri-Service MEPRS Management Improvement Group (MMIG) to proactively identify, investigate, and resolve MEPRS data anomalies in a timely, systematic manner. 4b: This question is only applicable to facilities with inpatient services. The SIDR is a patient-specific set of data captured in CHCS and reported to support bio-statistical analysis. SIDR processing in CHCS permits the update of patient information, the recalculation of workload, Medical Service Account/Third Party Collections billing data, and the retransmission of the SIDR whenever corrections are entered into CHCS. 4c: The WWR is a report that displays the collection of inpatient, outpatient, and ancillary medical workload data for the MTF that is summarized monthly used for workload reporting, and to make decisions that will have direct impact across the MHS spectrum. BDQAS WWR suspense is the 5th duty day after the month has ended so that it can be transmitted to EIDS by the 10th calendar day.   NOTE: Any corrections or adjustments made in CHCS, a WWR MUST be regenerated and resubmitted. 4d: SADRs must be transmitted daily to the MHS Data Repository. SADRs are automatically transmitted by CHCS via the CHCS System Electronic Transfer Utility (SY-ETU). If there is no data to transmit, an empty file will still generate and transmit. The system administrator will receive confirmation that the file was complete, or notice that the transfer was not successful from the recipient system. SADR processing may be rescheduled in the event of downtime or failed transmissions. AHLTA or Ambulatory Data Module (ADM coding will be performed daily and before the medical record leaves the clinic to ensure that data recorded in ADM reflects the actual medical record. The ADM manager will use the reports available in the CHCS ADM module to monitor daily completion statistics. Timely appointment closures in CHCS and consistent EOD processing must be emphasized for appointments that are made available for coding. Thus, timely ADM processing is dependent upon timely appointment closures in CHCS and consistent EOD processing. The CHCS or ADM administrator is typically the person in charge of the transmission of the SADR and verifying that the transmission was successful.

Data Quality 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 Question 5 is for inpatient services, 6 is for outpatient services, and 7 is for APV services Coding accuracy

Data Quality Statement Compliance 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? Breakdown of actual 5 questions 5a: This question is only applicable to facilities with inpatient services. DOD Instruction 6040.42, Medical Encounter and Coding at Military Treatment Facilities, 10 June 2004, requires that all medical encounters within the MHS be accurately coded, adhering to legal and medical coding classification standards as permitted by the MHS data collection systems. A random review of 30 (or more as set by Service-Level Guidance) records will be conducted 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%.   NOTE: This metric is a comparison of the paper record to the computerized coded information.

Data Quality Statement Availability/Accuracy Question 5. Inpatient Records. CONT… e) What percentage of completed and current (signed within the past 12 months) DD Forms 2569 (TPC Insurance Info) are available for audit? (How the patient answered is only relevant to answering “Question 6f”) The DD Forms 2569 need to be available and current at the time of the audit to be in compliance with the UBO program. Options for filing DD Form 2569: Maintain hardcopy DD Form 2569 in medical record Scan DD Form 2569 and store electronically Hardcopy DD Form 2569 stored in the MTF RMO/Business/TPC Office Collection of 2569s for inpatient visits for non-active duty members 5e: DD Form 2569 is to be completed for every non-active duty beneficiary and updated at least annually. During initial registration, clerks must ask each non-active duty patient if they have any type of medical coverage, other than TRICARE, and initiate the DD Form 2569. Upon subsequent visits, clerks must check that a current DD Form 2569 is available and initiate/update it as necessary. DD Form 2569 availability may be electronic or paper copy; DD Form 2569s may be maintained in a database, in the medical record, or in a MTF specific centralized location. Latest version dated MAR 2007 (previous editions are obsolete) can be found at: http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2569.pdf

Data Quality Statement Availability/Accuracy Question 5. Inpatient Records. CONT… f) What percentage of available, current and complete DD Forms 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS? Internal Process based on Question 6e. Does not apply to OCONUS bases. After collection of 2569’s did the Patient Insurance Information module in CHCS get updated to match the 2569 5f: Once the patient completes DD Form 2569, the patient insurance information needs to be updated in CHCS. The purpose of this question is to determine whether the patient has or does not have insurance. In some instances the information is in CHCS, but there is no record of it in the outpatient record, or in some cases the patient has insurance but it has never been entered in CHCS and your MTF is losing revenue because there is no billing generated. You may want to use the OHI Report to look into future appointments. Provide the clerks with those non-active duty dependants that do not have a 2569 in the record, and if their information in CHCS is not correct or needs to be updated.   EXCEPTION: Overseas OCONUS bases are exempt from this question.

Data Quality Statement Availability/Accuracy 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.) Source for a, b, c, d is Audit Tool Breakdown of actual 6 questions 6a: DOD Instruction 6040.43, 10 June 2004, Custody and Control of Outpatient Medical Records, establishes a document availability standard of 100%. “Availability” is defined as located within the MTF having functional responsibility for maintaining the record. Documentation includes documentation in the medical record, loose (hard copy) documentation or an electronic record of the encounter in AHLTA. Accountability must be maintained throughout the MTF through consistent, disciplined use of the CHCS Record Tracking Module. Clinic Clerks must be trained to account for records. Patients must be educated on the importance of returning records to the MTF.

Data Quality Statement Availability/Accuracy Question 6. Outpatient Records. CONT… e) What percentage of completed and current (signed within the past 12 months) DD Forms 2569s (TPC Insurance Info) are available for audit? Audit Tool Generated/Internal Process (This metric only measures whether or not a DD Form 2569 was collected/current in the record at the time of the encounter). The DD Forms 2569 need to be available and current at the time of the audit to be in compliance with the UBO program. f) What percentage of available, current and complete DD Forms 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS? Internal Process based on Question 6e. Does not apply to OCONUS bases. collection of 2569s fo After collection of 2569’s did the Patient Insurance Information module in CHCS get updated to match the 2569s for outpatient visits for non-active duty members 6e: DD Form 2569 is to be completed for every non-active duty beneficiary and updated at least annually. During initial registration, clerks must ask each non-active duty patient if they have any type of medical coverage, other than TRICARE, and initiate the DD Form 2569. Upon subsequent visits, clerks must check that a current DD Form 2569 is available and initiate/update it as necessary. DD Form 2569 availability may be electronic or paper copy; DD Form 2569s may be maintained in a database, in the medical record, or in a MTF specific centralized location. Latest version dated MAR 2007 (previous editions are obsolete) can be found at: http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2569.pdf 6f: Once the patient completes DD Form 2569, the patient insurance information needs to be updated in CHCS. The purpose of this question is to make sure that the patient has or does not have insurance. In some instances the information is in CHCS, but there is no record of it in the outpatient record. In some cases the patient has insurance but it has never been entered in CHCS and we are losing revenue because there is no billing generated. You may want to use the OHI Report to look into future appointments. Upon identifying non-active duty personnel that do not have a 2569 in their record, have incorrect data in CHCS, or are lacking current information, provide these names to the clerks so that the proper records and/or CHCS may be updated.   EXCEPTION: Overseas OCONUS bases are exempt from this question.

Data Quality Statement Availability/Accuracy Question 7. Ambulatory Procedure Visits (C.7.a,b,c,d,e) Questions 7.a,b,c,d,e Are the same as Questions 6.a,c,d,e,f

Data Quality Statement Completeness Question 8. Comparison of reported workload data. a) # SADR Encounters (count only) / # WWR visits Source is BDQAS b) # SIDR Dispositions / # WWR Dispositions Source is BDQAS c) # EAS Visits / # WWR Visits Source is BDQAS d) # EAS Dispositions / # WWR Dispositions Source is BDQAS e) # of Inpatient Professional Services Rounds SADR encounters (FCC=A***)/#Sum WWR (Total Bed Days + Total Dispositions) Note: FY10 Goal is 80% (Will be graded red and green only) Source is Monthly Statistical Report (Internal Process) Completeness of workload Change is that SADR encounters were count and non count where the WWR visits were only count so percentage did not accurately report, CHANGE FY10 8a: The BDQAS web site captures the number of encounters from the nightly SADR transmissions and the Monthly WWR transmissions. The SADR number includes both count and non-count encounters in "B" MEPRS and "FBN" MEPRS for appointments that have an appointment status in the End of Day Processing as Kept, Walk-in, Sick Call, and Tel-Con. The WWR includes only count appointments. If the encounters are lower you have incomplete encounters, see BDQAS monthly completion reports (drillable) for resolution. Run your ADM compliance reports to see how many encounters you have pending. The numbers displayed on the automated statement will display the completed SADR encounters BDQAS has received by the 10th of the month. The WWR will reflect the number of completed SADRS that were submitted by the suspense date. If your facility updates the WWR after the suspense date they will not display in the automated statement until the following month. You have to make a comment if your facility has sent a corrected WWR and is reporting local data. 8b: This question is only applicable to facilities with inpatient services. This is the ratio of SIDR completed ("D") records to the inpatient dispositions reported in the WWR. The WWR will reflect the number of completed SIDRS that were submitted by the suspense dates. If your facility updates the SIDR records after the suspense date they will not display in the automated statement until next mid-month transmission. Since reporting is almost 2 months behind, the numbers on the BDQAS web site should be final numbers for your MTF. You have to make a comment if your facility has more completed SIDRS but are waiting for the midmonth transmission. 8c: This is the ratio of EAS IV outpatient visits to the outpatient visits reported in the WWR. The WWR calculation in this question is different from that calculated in question 8a (SADR/WWR). In question 8a, the WWR total consists of outpatient visits only (which also includes inpatients with visits not related to the inpatient stay). For this question, EAS IV total visits additionally include inpatient visits related to the inpatient stay. Therefore we adjust the WWR total to include those extra visits. If your MTF have submitted a corrected EAS IV or have made a late transmission, let BDQAS staff know to refresh the data and update their files. Ensure corrections made in one data system are also made in the others. 8d: This question is only applicable to facilities with inpatient services. This is the ratio of EAS IV inpatient visits to the inpatient dispositions reported in the WWR. The EAS IV dispositions and visits are the numbers submitted by the MTF as of the suspense date and are downloaded from the AMPO repository. Please check with your RM or MEPRS staff to validate the information. If your MTF have submitted a corrected EAS IV or have made a late transmission, let BDQAS staff know to refresh the data and update their files. Ensure corrections made in one data system are also made in the others. 8e: This question is only applicable to facilities with inpatient services. An Industry Based Workload Alignment (IBWA) module was added to CHCS as part of a strategic initiative to align the MHS with the civilian sector and pave the way for inpatient itemized billing and a potential for increased third-party reimbursements. IBWA is now called Inpatient Professional Services Rounds (IPSR) and relates to the capture of inpatient encounters. When an attending physician rounds on a patient, details of the encounter are documented in the Ambulatory Data Module (ADM) in CHCS and a Standard Ambulatory Data Record (SADR) is generated. Documented rounds provide full visibility of inpatient workload to support future clinical and business decisions. With the implementation of the Prospective Payment System (PPS), staffing and budgets will be based on the productivity of the providers using the Relative Value Unit (RVU) generated by SADRs. The metric compares the number of documented rounds encounters (SADRs) with the number of bed days plus the number of dispositions for the month.

Data Quality Statement AHLTA Use Question 9. System Design, Development, Operations, and Education/Training (E.4.a). a. # of AHLTA SADR encounters / # of Total SADR encounters (ALL SADR encounters including APV and ER) Source is BDQAS 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. This question is to gauge the use of AHLTA at our MTFs This question is to gauge the penetration of AHLTA. It is understood that not all clinical modules are deployed in the current version of AHLTA. The SADR number includes both count and non-count outpatient encounters in "B" MEPRS and "FBN" MEPRS for appointments that have an appointment status in the End of Day Processing as Kept, Walk-in, Sick Call, and Tel-Con. Unlike previous years, Emergency Care ("BIA"), Immediate Care ("BHI"), APV ("B**5" and "B**7), and Observation ("B**0") clinics are not excluded.  

Data Quality Statement CHCS Duplicate Patients 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”. Duplicate patients, canned report Don’t just run report but fix the duplicate patients This question was added for Management Use and for Tracking Purposes Only. Potential duplicate patient records can be minimized by performing DEERS validation checks. CA>PAS>MAN>RMCP>RREG>DRDM. Use the demographics option to synchronize record after verification of DEERS data.

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 We have heard a lot of feedback on this. When you are explaining this to your MTF leadership, TMA has requested that only hosts sites report this question regardless of service to ensure that double counting potential duplicates is not occurring and to eliminate variance. If you are the CHCS platform you need to report all potential patient duplicates. You will need to come up with an internal process on if you are going to send out the potential duplicate patients to the facilities that caused the potential problem. If you are having a problem with other services not correcting potential duplicate patients, please forward your concern to us at AFMOA and we will forward to HAF to get with the other services to help correct the potential duplicates. We will give you a tool to be able to identify who caused the potential problem later in this briefing.

Patient Duplicate Reporting 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 This comes directly off the DQMC review list.

Patient Duplicate Reporting 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

Data Quality Statement Awareness Question 11. I am aware of data quality issues identified by the completed DQ Statement and DQMC Review List and when needed, have incorporated monitoring mechanisms and have taken corrective actions to improve the data from my facility. (Electronic Signature Authorized) Reminder the AF DQ MUG can help you how data was pulled The Data Quality Assurance Team (or other designated structure) must meet monthly to complete the DQMC Review List. The Data Quality Manager briefs the reporting month’s DQMC Review List and Financial and Workload Reconciliation and Validation results to the MTF Executive Committee. The Data Quality Manager briefs the MTF Commander and obtains the Commander’s approval and signature on the Commander’s Monthly Data Quality Statement, attesting to the status of the compliance measures listed in the monthly statement.