1. MEPRS 2010 From Source to Resource: Data Quality Solutions for Today's MEPRS Challenges 26 – 29 July Lansdowne, VA Briefing: MEPRS Fundamentals Speakers: Paulette Richards Sheri Weis Date: 29 July 2010 Time:1300 – 1500

3. MEPRS 2010 From Source to Resource: Data Quality Solutions for Today's MEPRS Challenges 26 – 29 July Lansdowne, VA MEPRS Fundamentals: Background Standard Tables Financial Processing Paulette Richards

4. MEPRS Fundamentals Objectives Understanding the basics of MEPRS Processing: Who… What… When… Where… Why… And HOW Financial, Workload and Personnel 4

5. WHY MEPRS Increased overhead and support costs The quality of systems for planning, management, and evaluation Anticipated physician shortages. The social equality of military medical care and its compatibility with national health care objectives. Uniform Chart of Accounts (UCA) aka MEPRS Joint study tasked to address four concerns:

6. WHY MEPRS 6 MTFs used separate & independent systems & data bases Valid comparisons between MTF and the Services could not be made Inconsistent & non-comparable data maintained Different interpretations of common data Performance Measurements UNIFORM CHART OF ACCOUNTS Reporting

7. STANDARD TABLES TRICARE MANAGEMENT ACTIVITY FCC Master – Standard to the third position of the Functional Cost Code (4th pos service unique ) Standard Documentation Code Table Service Element Expense Code (EEIC) Program Element Code (PEC)

8. 8 Functional Categories

9. ASD & EAS IV PROCESSING MODEL

10. HOW is the ASD is STORED o The table is stored in the EASi application. o NOTE: At the beginning of each year the table is reviewed. WHAT is an ASD? o ASD table is the dictionary listing of Functional Cost Codes (FCCs) which defines your MTF data reporting. This table defines what goes on in your MTF. Account Subset Definition (ASD) Table Fundamentals HOW is the ASD Created? o AF MEPRS SG establishes approved FCC codes with the ASN in a standard table for the entire AF. o MEPRS Manager reviews and submits their local table. HOW is the ASD Used o Determines if FCC are valid. o Contains the ASN which determines the order in which expenses from Intermediate accounts are allocated to Final accounts in the step-down process.

11. ASD – CRITERIA FOR FCC CREATION ASD CRITERIA Unique Accounts: Service provided must be unique and not duplicated/provided by another work-center. Expenses – Attributed to work-center. Expenses include: direct, resource sharing, contract and personnel. Workload Measure – Must have ability to measure meaningful workload identified in the DoD 6010.13M Physical space – A location where the services are provided, must be capable of being measured in square. Work-center : Must meet definition as outlined in DoD 6010.13-M Personnel – Must have assigned/available personnel as identified in the DoD 6010.13M

12. D&E FCCs require ASN Clear Description s Make sure all RC/CCs are current

13. ASD CREATION MODEL - OVERVIEW MEPRS/EAS LEADERSHIP ASD STRUCTURE ASD CHECKLIST FCC CRITERIA PEOPLE MANAGEMENT CLEAN MEPRS/EAS TABLES PE-MAP CHCS/WAM DMHRSI AIR FORCE MEPRS PROGRAM OFFICE AFMOA MEPRS STAFF MTF STAFF EXPENSES PHYSICAL SPACE MANPOWER MEASURABLE WORKLOAD MEPRS MGR BUDGET POC CHCS DBA MANPOWER POC VALIDATE ALL FCCs REVIEW ASN ALIGN EXTERNAL TABLES ADDRESS DUPLICATE FCCs FISCAL YEAR DMIS ID MEPRS/FCC CODES FCC DESCRIPTIONS ASN ACTIVATION DATE INACTIVATION DATE DEACTIVATION DATE VALIDATE SITE DEFINABLE TABLE VALIDATE EACH PROJECT AND TASK VALIDATE AF SG FIINANCIAL GUIDANCE RCCC/MEPRS TABLE MEPRS/EAS DATA QUALITY RELATIONSHIP LEARNING ASD CREATION PROCESSDATY QUALITY VALIDATION RESULTS

14. ASD STAKEHOLDERS PEOPLE MANAGEMENT MEPRS MANAGER Budget Office – Involved with correcting and identifying expenses associated with the work-center Logistics Office – Ensure proper reporting of supplies, equipment, square footage and depreciation RMO CHCS DBA – Ensure the CHCS table is properly reporting workload for each MEPRS/FCCs Manpower Office – Ensure the Activity Manning Document is up-to -date.

15. ASD CHECKLIST HELPFUL NOTES INACTIVATE DATES will cause a warning in the error correction unit (ECU) during the initial validation process. ADD an FCC: Ensure MEPRS/FCCs are aligned with DoD 6010.13M D and E FCC require ASN INACTIVATE an FCC: This is a TEMPORARY date and can only occur in the current fiscal year. * The date range must be within the current FY DEACTIVATE an FCC: This is a PERMANENT date. * Date cannot be before the beginning of the current year (30 Sep FY) REACTIVATE an FCC: You will need to re-enter a current dat within the current fiscal year. * Change the inactivate Date Range. FCCs can be added or reactivated in mid- year. Ensure the default date is changed. TEAM EFFORT - All FCCs should be reviewed by RMO team and validated against the AF FCC Master Table.

16. PURPOSE & IMPACT Summary  The ASD is the roadmap which defines MTF unique data used by Expense Assignment System (EAS ) processing.  MEPRS utilizes Standardized business rules for collecting, calculating and reporting data used for clinical and management decisions.  Standard tables are published and maintained by TMA ensure MHS follow standardized business rules.

17. FINANCIAL PROCESSING

18. COMMANDERS RESOURCE INTERGRATION SYSTEM CRIS 18 Program Element Code AF four-tier structure for handling funds : Budget Activity Group Responsibility Code Cost Center Service Unique Expense Element

19. COMMANDERS RESOURCE INTERGRATION SYSTEM (CRIS) 19

20. 20 EASIV PURE FILE

21. 21 Eff Date BQ Site Field Site (OPLOC) Operating Agency Code (OAC) OAC Desc Operating Budget Account Number (OBAN) OBAN Desc FY (4 Char) OBY (4 Char) Fund Type (FT) Fund Code (FC) Program Element Code (PEC) Element of Expense/Investment Code (EEIC) Resource Center/Cost Center (RCCC) BQ Amount Bal ID (E & U) Bal ID Desc Row Count DMIS ID (OBAN) FCC RC/CC SEEC (EEIC) BSL (FC) PEC SOF Schedule Type Oblig. Fiscal Year Oblig. YTD Expense YTD (BQ Amount) CRIS & EASIV PURE DATA ELEMENTS CRIS EASIV Pure File

22. EASIV IMPORTS CRIS Data 22 CRIS EASIV PURE PEC 6 Digit PEC 5 Digit FCCSEECFCEEIC RCCC $2,999,999

23. 23

24. FINANCIAL DATA OVERVIEW 24 What should I do to make sure MEPRS Financial data is accurate? Become familiar with data elements (PECs/RC/CC) and how they relate to FCCs. Become intimately familiar with the Financial Program Element (PE) Map table that is provided each year by AF MEPRS Program Mgr Know what data should be reported in MEPRS. Each work center must be mapped to a cost center Coordination between MEPRS Mgr, Logistics, Budget and Resource Mgr.

25. ALLOCATION PROCESS IN THE EAS IV PROCESSING MODEL

26. DEFINITION: Allocation is the reassignment (step down) of intermediate operating accounts (D & E ) expenses to final operating accounts (A, B, C, F and G) on the basis of the ASN from the ASD. WHY WE DO COST ALLOCATION: Provides the “Total Cost of Doing Business” o Incorporates overhead expenses (Utilities, depreciation, housekeeping, etc.) o Determines total “unit cost” o Provides comparability with the civilian sector cost allocation methods

27. DEFINITION: The reassignment of intermediate operating (D & E) expenses is performed on the basis of assignment factors or ratios that measure the amount of services rendered by intermediate work centers to the other work centers. WHY WE DO COST ALLOCATION: Provides the “Cost of Doing Business” o Incorporates overhead expenses (Utilities, depreciation, housekeeping, etc.) o Determines real “unit cost” o Provides comparability with civilian sector cost allocation methods

28. Expense from FCC’s with an ‘X’ in the third position (COST POOLS) are distributed to final accounts based on the ratios calculated using the cost pool data set Text ACA%ADA% ABA%AAA% PURIFICATION PROCESS A_X

30. STEPDOWN aka ALLOCATION E & D $2,559,987 E% D% A% B% C% F% G% Intermediate accounts are stepped down based on the order of the assignment sequence number (ASN) listed on the ASD E & D $0

31. ALLOCATION SCENARIO DSI Workload AAAA BAAA BGAA CAAA DAAA EBAA Total EBAA Total: 380 380 100 50 150 45 35 26.31579 13.15789 39.47368 11.84211 9.21053 Ratio 100 50 150 45 35 FCC: EBAA – Command & Admin DSI: FTEs

32. ALLOCATION SCENARIO 26.31579 13.15789 39.47368 11.84211 9.21053 Ratio EBAA Expense to be Distributed $10,000 X Expense distributed $2,631.58 1,315.79 3,947.37 1,184.21 921.05 AAAA BAAA BGAA CAAA DAAA FCC: EBAA – Command & Admin DSI: FTEs % Total Expenses: $10,000

33. ALLOCATION OVERVIEW DAAA - Pharmacy DSI: PHARMACY Expense received from step-down: Total expense to be distributed: SAS 301 Workload AAXA AAAA BAAA BGAA CAAA DAAA Total: 200 DAAA Total -25 175 28.57143 5.71429 14.28571 42.85714 8.57143 50 10 25 75 15 Ratio 50 10 25 75 15 25 175 $921.05 $100,921.05

34. DAAA - Pharmacy Data Set ID: Pharmacy Direct Expenses: Expense received from step-down: Total expense to be distributed: AAAA BAAA BGAA CAAA % of Data Set Total DAAA Expense to be Distributed $100,921.05 X Expense distributed $28,834.59 5,766.92 14,417.29 43,251.88 8,650.38 28.57143 5.71429 14.28571 42.85714 8.57143 $100,000.00 $921.05 $100,921.05

35. ALLOCATION REPORTS Allocation Summary Allocation Ratios ASN Verification Expense Accepted/ Allocated Detail Expense Allocated Personnel Accepted/ Allocated Data Set Accepted/Allocated

36. MEPRS 2010 From Source to Resource: Data Quality Solutions for Today's MEPRS Challenges 26 – 29 July Lansdowne, VA MEPRS Fundamentals: Workload and Personnel Processes Sheri Weis

37. EAS Processes: Workload 37 System-Generated Data and Non-System Generated Data

38. EAS Processes: Workload System Generated Data  CHCS: Workload Assignment Module (WAM)  Data Sets: ADM Dispositions Occupied Bed Days Outpatient Visits Pharmacy (DAAA) Total Visits Radiology (DCAA) Pathology (DBAA) (only Lab and Rad provide CPT workload data) 38

39. EAS Processes: Workload System Generated Data: WAM 39  WAM is a Tri-Service component of CHCS that standardizes and streamlines workload reporting for MEPRS/EAS.  Workload templates are created at the beginning of each month using the Initialization action.  All Data Set Identification (DSI) must be in Approved status for the ASCII file to be either created or re-created.  The ASCII file must be generated, before it’s transmitted to EAS via electronic interface.

40. EAS Processes: Workload System Generated Data: WAM 40

41. EAS Processes: Workload Non-System Generated Data 41  Dental Services Account Data Sets  Ancillary Services Accounts Data Sets  Lab/Rad/Pharmacy are system-generated  Support Services Accounts Data Sets  Special Program Accounts Data Sets  Readiness Program Accounts Data Sets  Square Footage and Square Footage Cleaned

42.  Ancillary Services Accounts Data Sets (D***) 42 EAS Processes: Workload Non-System Generated Data

43. 43  Support Services Accounts Data Sets (E***)

44. EAS Processes: Workload Non-System Generated Data  Special Program Accounts Data Sets (F***) 44

45. EAS Processes: Workload Non-System Generated Data  Readiness Program Accounts Data Sets (G***) 45  Captures only War Reserve Medical (WRM) readiness workload performed at your local facility- $ amounts. (GEAA)  Square Footage and Square Footage Cleaned  The Facility section should provide square footage information.  Be sure to make all corrections in the first month of the fiscal year.  Compare Square Footage with the Square Footage Cleaned to ensure the correct values are being reported.

46. EAS Processes: Workload Datasets 46 Example

47. EAS Processes: Workload Steps 1. Import monthly CHCS/WAM file 2. Validation: select “ Available to Validate” 3. Address Errors and Warnings in the ECU: research, correct and re-validate 4. Enter Non-System Generated Reports under Adjustments-Workload-Data Sets 47

48. EAS Processes: Workload Reconciliation 48  CHCS Reports:  World Wide Workload Report (WWR):  Validate monthly CHCS WAM workload prior to transmittal to EAS IV  Follows the same business rules for calculating workload as WAM  Can be used to validate Occupied Bed Days and Admissions  Monthly Statistical Report:  Count and Non-Count for In-/Out-Patient areas by MEPRS Code; in-depth look at discrepancies between the WWR and EASIV  End of Day processing must be completed before the MSR can be generated

49. EAS Processes: Workload Stakeholders 49 MEPRS EAS

50. EAS Processes: Personnel 50

51. EAS Processes: Personnel 51 Good, basic stuff to know:  1 FTE = 168 hours /month  Where are they?  Available/Non-Available Time  5 Skill Types + Occupation Codes-what are they?

52. EAS Processes: Personnel Good basic stuff to know: 1 FTE = 168 hours /month Are personnel assignments correct Report all Available/Non-Available Time 5 Skill Types + Occupation Codes-what are they? 52

53. EAS Processes: Personnel DMHRSi  LCA Specialist: DMHRSi Output File  DoD Create EASIV Extract File_XXXXXX (Text file for importing into EAS)  After creating the DMHRSi output file, run the EAS IV Assigned Personnel and EAS IV Summary View reports- will help you to investigate errors  Note: Personnel errors cannot be adjusted in EAS. They must be corrected in the source system (DMHRSi), then re-imported. 53

54. EAS Processes: Personnel Steps 54 1. All personnel time has been processed for the month! 2. DMHRSi-DoD EASIV CREATE FILE : save as text file for import 3. Upload Personnel file 4.Import Personnel file 5.Validation: select “ Available to Validate” 6. Address Errors and Warnings in the ECU: research, make corrections in DMHRSi, re-import and re- validate

55. EAS Processes: Personnel Reconciliation  Compare the DMHRSi EAS IV Summary View Report with the EASIV Personnel Allocated Report to ensure that the total FTEs match 55

56. 56 FHI Implementation 13 Sites completed by end of 2009 Edwards & Ellsworth (2008) ScottMisawa PatrickFE Warren AndrewsBolling HillSheppard Laughlin Elmendorf Lakenheath 20 “Homes” to be “built” in 2010 BarksdaleMcGuire CharlestonOffutt ColumbusRamstein Davis-MonthanRandolph GoodfellowShaw Hickam Spangdahlem Hurlburt Travis KeeslerVance LangleyWright Patterson LukeYokota

57. EAS Processes: Workload Stakeholders 57 MTF Staff (Timecards!) HR Manager Manpower MEPRS LCA Manager EAS

58. EAS Processes: Workload and Personnel 58

59. Resources… 59 DoD 6010.13-M Air Force Instructions 41-102 DoD 6010.13-M - Medical Expense & Performance Reporting System for Fixed Military & Dental Treatment Facilities Manual AF MEPRS Users Guide - MUG Defense Health Services Systems - Expense Assignment System IV (EAS IV) Application Functional Users Guide (FUG) December 2009 Secretary of the Air Force – Air Force Instructions 41-102 31 March 2008 – Air Force Medical Expense & Performance Reporting System for Fixed Military & Dental Treatment Facilities SGY & AFMOA – Air Force MEPRS Support Staff (Washington/San Antonio) Vector Check - https://vc.afms.mil/AFMOA/SGA/SGAR/SGAR_MEPRS/default.aspx Vector Check

60. Questions? 60 MEPRS Personnel Workload Financial UBO Other Health Insurance Eligibility Demographics Coding SIDR/SADR MSDRG/RWP RVU/CPT Patient & Provider Data Quality

61. 61 NameMAJCOMPhone DSN (969) EMAIL Keith AndreAFGS, ACC210-395-9228Keith.andre.1@us.af.mil Dave CollinsAFMC, AFSPC, USAFE, PACAF 210-395-9206Charles.collins.12.ctr@us.af.mil Paulette Richards AFGS, ACC210-395-9225Paulette.richards@us.af.mil Dawn SimmonsAETC, AFDW, AMC, AFSOC, USAFA 210-395-9239Dawn.simmons.1.ctr@us.af.mil Sheri WeisAETC, AFDW, AMC, AFSOC, USAFA 210-395-9123Sherilyn.weis.ctr@us.af.mil TSgt Jeff Zukowski AFMC, AFSPC, USAFE, PACAF 210-395-9207Jeffrey.zukowski@us.af.mil

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