1. Excellent Healthcare, Clinical Currency Air Force Medical Operations Agency Air Force TMA DQ Course Break-Out Session 1 May 10 AFMOA/SGAR

2. 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

3. 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 3

4. Excellent Healthcare, Clinical Currency Integrated Approach 4 MEPRS Personnel Workload Financial UBO Other Health Insurance Eligibility Demographics Coding SIDR/SADR MSDRG/RWP RVU/CPT Patient & Provider Data Quality

5. Excellent Healthcare, Clinical Currency DQ Program Manager 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

6. 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 CY10 on Vector Check DCO is the primary tool used to conduct meetings and take attendance

7. 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

8. 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.

9. Excellent Healthcare, Clinical Currency

10. 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

11. 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\

12. Excellent Healthcare, Clinical Currency Vector Check Alerts 12 Click on your name.

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

20. Excellent Healthcare, Clinical Currency 20 Why is Data Quality Important? To accurately reflect the work performed in your MTF

21. 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)

22. Excellent Healthcare, Clinical Currency Integrated Approach 22 MEPRS Personnel Workload Financial UBO Other Health Insurance Eligibility Demographics Coding SIDR/SADR MSDRG/RWP RVU/CPT Patient & Provider Data Quality

23. Excellent Healthcare, Clinical Currency 23 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

24. Excellent Healthcare, Clinical Currency 24 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

25. 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 25

26. Excellent Healthcare, Clinical Currency 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

27. Excellent Healthcare, Clinical Currency 27 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)…DQ 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

28. Excellent Healthcare, Clinical Currency DQ MUG 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 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:

29. Excellent Healthcare, Clinical Currency 29 DQ MUG Format 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. 8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions? 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 1.Go to Data Quality Reports-Data Quality Statement Reports. 2.Find your Major Command, then your Facility and then the correct reporting month. 3.Find the monthly percentage for Question 8d. 8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions? https://kx.afms.mil/kxweb/dotmil/file/web/ctb_117012.pdf

30. Excellent Healthcare, Clinical Currency 30 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 https://kx.afms.mil/kxweb/dotmil/file/web/ctb_098772.pdf - Supplements AF Coding Guidelines - Published by AF Coding Experts

31. Excellent Healthcare, Clinical Currency 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

32. 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, 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

33. 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 33

34. Excellent Healthcare, Clinical Currency 34 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

35. Excellent Healthcare, Clinical Currency 35 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

36. Excellent Healthcare, Clinical Currency 36 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”

37. Excellent Healthcare, Clinical Currency CHCS Provider File Errors and Error Criteria 37

38. Excellent Healthcare, Clinical Currency CHCS Provider File Errors and Error Criteria (cont) 38

39. Excellent Healthcare, Clinical Currency 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 39

40. Excellent Healthcare, Clinical Currency 40 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

41. Excellent Healthcare, Clinical Currency 41 Volume and error types will dictate cleanup strategies Monthly error rates for the MTF

42. Excellent Healthcare, Clinical Currency Provider Report Card (continued – page 2) 42 Peer Group Comparison

43. Excellent Healthcare, Clinical Currency 43 Provider Details Report

44. Excellent Healthcare, Clinical Currency 44 AFMOA DQ Provider File Roles/Responsibilities

45. Excellent Healthcare, Clinical Currency 45 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

46. Excellent Healthcare, Clinical Currency 46 MTF DQ Team Provider File Roles/Responsibilities

47. Excellent Healthcare, Clinical Currency 47 “New and Improved” 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 Improvement progress tracked on Vector Check AFMOA UFR to centrally procure HCIdea website subscription for MTFs to support their correction efforts, $50K annually

48. Excellent Healthcare, Clinical Currency Other Data Quality Efforts 48 AFMOAAMCAFMSADHIMS Function:Comprehensive CHCS Clean-up CHCS Patient File Clean-up - SME Support - Training Auto Merge Duplicate Patient CHCS/AHLTA using COTS Role:ID/Facilitate/PreventID/Fix/Prevent Contractor:PSI (prime) Smartronix (sub) Evolvent (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

49. Excellent Healthcare, Clinical Currency Patient Registration DQ Team

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

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

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

53. Excellent Healthcare, Clinical Currency ADPM Initiative (cont)

54. Excellent Healthcare, Clinical Currency ADPM Initiative (cont) - Theater Medical Data System (TMDS) - AHTLA/CDR - CHCS

55. 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

56. 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

57. Excellent Healthcare, Clinical Currency

58. 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) DQ Review List/Statement Comments

59. Excellent Healthcare, Clinical Currency 59 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

60. Excellent Healthcare, Clinical Currency 60 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

61. Excellent Healthcare, Clinical Currency 61 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

62. Excellent Healthcare, Clinical Currency DQ Review List/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 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

63. Excellent Healthcare, Clinical Currency Select Data Metrics

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

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

66. 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 MUG if needed

67. Excellent Healthcare, Clinical Currency 67 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

68. Excellent Healthcare, Clinical Currency 68 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

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

70. Excellent Healthcare, Clinical Currency User guide is very helpful step by step tool. Also you can download an excel file of you MEWACS info. Click here

71. Excellent Healthcare, Clinical Currency Data Load Status WWR/EAS IV Summary Outliers Allocation Test

72. Excellent Healthcare, Clinical Currency Data Load Status

73. Excellent Healthcare, Clinical Currency Summary Outliers

74. Excellent Healthcare, Clinical Currency WWR/EAS IV

75. Excellent Healthcare, Clinical Currency Allocation Test

76. 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 76 AFMOA MEPRS Dashboard

77. Excellent Healthcare, Clinical Currency 77 AFMOA MEPRS Dashboard Nellis AFB, Nov 2009 Validated Error Errors Research

78. Excellent Healthcare, Clinical Currency 78 AFMOA MEPRS Dashboard Nellis AFB, Apr 2010 Research Corrections Pending Corrected Validated Research

79. Excellent Healthcare, Clinical Currency 79 DQ Review List/Statement Validation and Reconciliation Question C.1.e. & f. (DQ Statement question 3.c) Continued…New Questions on Timecards submitted by close of business the Monday after the end of the pay period 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

80. 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

81. Excellent Healthcare, Clinical Currency 81 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

82. 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 82

83. 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 83 Patient Duplicate Reporting

84. 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 84 Patient Duplicate Reporting

85. Excellent Healthcare, Clinical Currency 85 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 of Day of the month) Source is BDQAS C.3.c. (DQ Statement question 4.c.) WWR/CHCS (10 th Calendar Day Following 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

86. Excellent Healthcare, Clinical Currency 86 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

87. Excellent Healthcare, Clinical Currency Diverse MAJCOM and MTF contract solutions Inconsistent coding Staffing models Workload requirements Training practices Performance/DQ Funding sources with variable reliability Self-Audits are common and not objective Fragmented comm b/n MTF, MAJCOM, HQ AFMS Suboptimal compliance w/ AMA/DoD/AFMS guidance AFAA audit conclusion: “Medical coding effectiveness required significant improvement in all areas” AFMS Coding In Transition

88. Excellent Healthcare, Clinical Currency “MTF personnel were inappropriately allowed to use the same contractor for both coders and auditors, creating a significant conflict of interest” “All 9 MTFs had coding error rates of 50% or higher” “36% of encounters contained diagnoses coding errors, increasing the potential for subsequent providers to incorrectly treat or delay patient treatment” “Medical personnel did not identify specific system and coding training needs, develop a reliable plan to address providers’ needs, or adequately track provider training” AFAA: AFMS Coding Findings

89. Excellent Healthcare, Clinical Currency “Create a centralized AFMS outpatient coding contract to place a pre-determined number of coding support personnel at every MTF” “Require independent auditors accomplish AFMS audits” “Establish and implement an Air Force-wide training plan to educate and train providers on coding requirements to include DoD, Air Force, and AMA standards” “Implement procedures to track providers’ coding performance, to identify providers’ coding strengths and weaknesses, and provide individualized training to correct deficiencies” AFAA Recommendations agreed to by AF/SG

90. Excellent Healthcare, Clinical Currency Coding Initiative Objectives Robust support is paramount Standardization is attainable and pragmatic but will not succeed without leadership endorsement Dispel the myth that “More coding is better” New focus on coding only what is needed Utilize IM/IT systems to fullest potential Target training based upon identified errors Ongoing provider training is vital! Endorse continued evaluation for Dynamic enhancements (address lessons learned) Incorporation of billing and coding into one contract

91. Excellent Healthcare, Clinical Currency Central Coding Contract Why Centralization of coding and auditing contracts was driven by AFMS, AFAA, and AF/SG concerns Centralization equivocally aligns the coding and auditing assets across all CONUS MTFs Centralization answers the requirement to eliminate biased self-auditing practices Provider workload driven by this change is small Coding 100% of encounters is expensive and does not provide better data quality Centralized concept saves AFMS dollars and provides higher fidelity coding

92. Excellent Healthcare, Clinical Currency Centralized Coding Contract Outpatient Coding support for CONUS* MTFs All ER and APU (Procedure visit) encounters coded All Billables/TPCs will be coded Additional 10% of outpatient visits coded Strong emphasis on Coding Trainers Provide general & targeted instruction 100% coding model not chosen because evidence does not show it improves DQ, and it is high cost ($40M+) Centralized Auditing Contract Remote cell apart from MTFs, utilize CAT/CARS Audit, track, report and communicate training needs Develop similar vehicle for true OCONUS sites AFMS Coding Contract Way Ahead

93. Excellent Healthcare, Clinical Currency AFMS Centralized Coding and Auditing Contracts Two distinct contracts Answers 6 AFAA identified deficiencies Standardizes workload and resources to all MTFs Objectively audits coding at every MTF Supports provider education and training needs Coordinates management through AFMOA Meets urgent expiration deadlines for 36 MTFs $12.6M uniform solution vs. $20.5M disparate model Maintaining the status quo would not address AFMS needs or AFAA recommendations AFMS Coding Contract Way Ahead (cont)

94. Excellent Healthcare, Clinical Currency AFMS Coding Contract Conclusion Centralization of coding and auditing contracts was driven by AFMS, AFAA, and AF/SG concerns Centralization equivocally aligns the coding and auditing assets across all CONUS MTFs Centralization answers the requirement to eliminate biased self-auditing practices Provider workload driven by this change is small Coding 100% of encounters is expensive and does not provide better data quality Centralized concept saves AFMS dollars and provides higher fidelity coding

95. Excellent Healthcare, Clinical Currency 95 DQ Review List/Statement Compliance Question C.5. (Data Quality Statement 5 series questions) Outcome of monthly inpatient coding audit C.5.c) Percentage of inpatient records whose assigned DRG codes were correct? C.5.f) Inpatient Professional Services Rounds encounters E & M codes audited and deemed correct? C.5.g) Inpatient Professional Services Rounds encounters ICD-9 codes audited and deemed correct? C.5.h) Inpatient Professional Services Rounds encounters CPT codes audited and deemed correct? > 95% = Green > 80% < 95% = Yellow < 80% = Red

96. Excellent Healthcare, Clinical Currency 96 DQ Review List/Statement Availability/Accuracy Question C.5. Inpatient Records (continued) C.5.i) 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. > 95% = Green > 80% < 95% = Yellow < 80% = Red 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

97. Excellent Healthcare, Clinical Currency AFMS TPC Central Contract In Transition OLD (2004) AND NEW (2009) THIRD PARY COLLECTIONS CONTRACT COMPARRISON REQUIRMENT OLD CONTRACTNEW CONTRACT MTFContractorMTFContractor Directly facilitate and support: Other Health Insurance (OHI) identification/verification X X Claims Submissions for CHCS inpatient X X MSA CIV X X manual billing for ancillary care X X Accountability for ensuring deposits and payment posting X X Post all payments in TPOCS X X Post all payments in CHCS X X Ensure checks are sent to proper MTF Xnot specified Copy checks and provide copies to contractor X not specified MSA (excluding CIV ER) and MAC programs X X MSA Overseas Pay Patient Program: Send I&R from CHCS to contractor N/AX Send medical documentation (if not available from ADM remotely) N/AX Enter information into TPOCS and bill pay patient's insurance N/A X Provide all personnel, supervision, training, and services necessary to perform billing and collection X X Assist with program marketing, education, training to beneficiaries and MTF staff Xnot specified Complete TPC quarterly report (DD form 2570) and provide to MTF X X Provide a full time program manager at MTF during normal business hours X X Update and input patient insurance information in CHCS and TPOCS or other databases as required by the MTF Xnot specified Ensure all DD Form 2569 are collected from each patient access point and data entered into CHCS for populating the OHI and Standard Insurance Table Xnot specified Prepare and mail or transmit claims to third party payer X X Write offs shall not occur until MTFs approve action XX

98. Excellent Healthcare, Clinical Currency 98 DQ Review List/Statement Availability/Accuracy Question C.5. Inpatient Records. CONT… C.5.j) 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. > 95% = Green > 80% < 95% = Yellow < 80% = Red

99. Excellent Healthcare, Clinical Currency 99 DQ Review List/Statement Availability/Accuracy Question C.6. (Data Quality Statement series 6 questions) Outpatient Records C.6.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.) C.6.b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.) C.6.c) What is the percentage of ICD-9 codes deemed correct? C.6.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 > 95% = Green > 80% < 95% = Yellow < 80% = Red

100. Excellent Healthcare, Clinical Currency 100 DQ Review List/Statement Availability/Accuracy Question C.6. Outpatient Records (continued) C.6.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. C.6.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. > 95% = Green > 80% < 95% = Yellow < 80% = Red

101. Excellent Healthcare, Clinical Currency 101 DQ Review List/Statement Availability/Accuracy Question C.7. Ambulatory Procedure Visits (Data Quality Statement series 7 questions) (C.7.a,b,c,d,e) Questions C.7.a,b,c,d,e Are the same as Questions C.6.a,c,d,e,f > 95% = Green > 80% < 95% = Yellow < 80% = Red

102. Excellent Healthcare, Clinical Currency 102 DQ Review List/Statement Completeness Question C.8. (Data Quality Statement series 8 questions) Comparison of reported workload data. C.8.a) # SADR Encounters (count only) / # WWR visits Source is BDQAS C.8.b) # SIDR Dispositions / # WWR Dispositions Source is BDQAS C.8.c) # EAS Visits / # WWR Visits Source is BDQAS C.8.d) # EAS Dispositions / # WWR Dispositions Source is BDQAS C.8.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) > 95% = Green > 80% < 95% = Yellow < 80% = Red

103. Excellent Healthcare, Clinical Currency 103 DQ Review List/Statement AHLTA Use Question E.4.i. (Data Quality Statement question 9) System Design, Development, Operations, and Education/Training. 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. > 80% = Green < 80% = Red

104. Excellent Healthcare, Clinical Currency 104 DQ 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) “Yes” = Green “No” = Red (comments required) Do not use N/A

105. 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 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 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

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

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

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

109. Excellent Healthcare, Clinical Currency eDQ Rejection Sample

110. Excellent Healthcare, Clinical Currency 110 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

111. Excellent Healthcare, Clinical Currency 111 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/

112. Excellent Healthcare, Clinical Currency 112 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

113. Excellent Healthcare, Clinical Currency 113 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

114. 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 114

115. Excellent Healthcare, Clinical Currency 115 Data Quality Program Office Questions? Data Quality Umbrella Data Quality Foundation