1 data quality management control program army – mr. angel padilla

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Data Quality Data Quality Management Control Management Control

ProgramProgram

Army – Mr. Angel PadillaArmy – Mr. Angel Padilla

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OverviewOverview• Regulatory GuidanceRegulatory Guidance• Program ManagementProgram Management• Organizational FactorsOrganizational Factors• System Inputs, System Inputs,

Processes, and OutputsProcesses, and Outputs– CHCSCHCS– ADMADM– MEPRS/EASMEPRS/EAS– TPOCSTPOCS– MEWACSMEWACS

• Patient Records Patient Records AccountabilityAccountability

• Coding AuditsCoding AuditsSampling Size and Sampling Size and

TechniquesTechniquesInpatient RecordsInpatient RecordsOutpatient RecordsOutpatient Records

• Workload ComparisonWorkload Comparison• System SecuritySystem Security• System Design, System Design,

Development, Development, Operations, and Operations, and Education and TrainingEducation and Training

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Regulatory GuidanceRegulatory GuidanceDODI 6040.40DODI 6040.40

Military Health System Data Quality Management Military Health System Data Quality Management Control ProceduresControl Procedures

Department of DefenseDepartment of Defense

INSTRUCTIONINSTRUCTION

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Regulatory GuidanceRegulatory GuidanceDODD 6040.41DODD 6040.41

Medical Records Retention and Coding at Military Medical Records Retention and Coding at Military Treatment FacilitiesTreatment Facilities


DIRECTIVEDIRECTIVE

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Medical Encounter and Coding at Military Treatment Medical Encounter and Coding at Military Treatment FacilitiesFacilities


DIRECTIVEDIRECTIVE

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Custody and Control of Outpatient Medical RecordsCustody and Control of Outpatient Medical Records


DIRECTIVEDIRECTIVE

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Program ManagementProgram Management• Data Quality ManagerData Quality Manager• Data Quality Assurance TeamData Quality Assurance Team• Intermediate Command DQ ManagerIntermediate Command DQ Manager• Service Data Quality ManagerService Data Quality Manager• DQMC Review ListDQMC Review List• Commanders Monthly Data Quality Commanders Monthly Data Quality

Statement (internet based)Statement (internet based)

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System Inputs, Processes, System Inputs, Processes, and Outputsand Outputs

• Composite Health Care System (CHCS)Composite Health Care System (CHCS)• Armed Forces Health Longitudinal Armed Forces Health Longitudinal

Technology Application (AHLTA)Technology Application (AHLTA)• Ambulatory Data Module (ADM)Ambulatory Data Module (ADM)• Medical Expense and Performance Medical Expense and Performance

Reporting System (MEPRS) / Expense Reporting System (MEPRS) / Expense Assignment System (EAS)Assignment System (EAS)

• Third Party Outpatient Collection System Third Party Outpatient Collection System (TPOCS)(TPOCS)

• MEPRS Early Warning and Control MEPRS Early Warning and Control System (MEWACS)System (MEWACS)

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Data InputData InputMEPRS/EAS, ADM, CHCS, MEPRS/EAS, ADM, CHCS,

TPOCSTPOCS• Written ProceduresWritten Procedures• Current VersionsCurrent Versions• Upgrades & UpdatesUpgrades & Updates• Rejected RecordsRejected Records• End of Day Processing End of Day Processing

– Percentage of ClinicsPercentage of Clinics– Percentage of AppointmentsPercentage of Appointments

• Timely Coding Completion Timely Coding Completion

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Commander’sCommander’sData Quality StatementData Quality Statement

• Q. 1. In the reporting month:Q. 1. In the reporting month:– a) What percentage of clinics have a) What percentage of clinics have

complied with “End of Day” processing complied with “End of Day” processing requirements, “Every clinic – Every requirements, “Every clinic – Every day? (B.5.(a.))day? (B.5.(a.))

– b) What percentage of appointments b) What percentage of appointments were closed in meeting your “End of were closed in meeting your “End of Day” processing requirements, “Every Day” processing requirements, “Every appointment – Every day?” (B.5.(b))appointment – Every day?” (B.5.(b))

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• Q. 2. In accordance with legal and Q. 2. In accordance with legal and medical coding practices, have all of medical coding practices, have all of the following occurred:the following occurred:– a) What percentage of Outpatient a) What percentage of Outpatient

Encounters, other than APVs, have been Encounters, other than APVs, have been coded within 3 business days of the coded within 3 business days of the encounter? (B.6.(a))encounter? (B.6.(a))

– b) What percentage of APVs have been b) What percentage of APVs have been coded within 15 days of the encounter? coded within 15 days of the encounter? (B.6.(b))(B.6.(b))

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• Q. 2. In accordance with legal and Q. 2. In accordance with legal and medical coding practices, have all of medical coding practices, have all of the following occurred:the following occurred:– c) What percentage of Inpatient records c) What percentage of Inpatient records

have been coded within 30 days after have been coded within 30 days after discharge? (B.6.(c))discharge? (B.6.(c))

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Data OutputData OutputMEPRS/EAS, ADM, CHCS, MEPRS/EAS, ADM, CHCS,

TPOCSTPOCS• EASEAS

– Financial Reconciliation Financial Reconciliation – Inpatient and Outpatient Workload Inpatient and Outpatient Workload

ReconciliationsReconciliations– MEWACS ReviewMEWACS Review– Timely Data TransmittalTimely Data Transmittal– Workload ComparisonWorkload Comparison

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• Q. 3. In accordance with TMA policy, Q. 3. In accordance with TMA policy, “Implementation of EAS/MEPRS Data “Implementation of EAS/MEPRS Data Validation and Reconciliation,”Validation and Reconciliation,” dated 21 Dec dated 21 Dec 99 and “MEPRS Early Warning and Control 99 and “MEPRS Early Warning and Control System,” dated 28 May 02, along with the System,” dated 28 May 02, along with the most current Service-Level Guidance: (C.1.)most current Service-Level Guidance: (C.1.)

– a) Was monthly MEPRS/EAS financial a) Was monthly MEPRS/EAS financial reconciliation process completed, reconciliation process completed, validated and approved prior to validated and approved prior to monthly MEPRS transmission?monthly MEPRS transmission?

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• Q. 3. In accordance with TMA policy, Q. 3. In accordance with TMA policy, “Implementation of EAS/MEPRS Data “Implementation of EAS/MEPRS Data Validation and Reconciliation,”Validation and Reconciliation,” dated 21 dated 21 Dec 99 and “MEPRS Early Warning and Dec 99 and “MEPRS Early Warning and Control System,” dated 28 May 02, along Control System,” dated 28 May 02, along with the most current Service-Level with the most current Service-Level Guidance: (C.1.)Guidance: (C.1.)

– b) Were monthly Inpatient and b) Were monthly Inpatient and Outpatient workload reconciliation Outpatient workload reconciliation processes completed?processes completed?


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• Q. 3. In accordance with TMA policy, Q. 3. In accordance with TMA policy, “Implementation of EAS/MEPRS Data Validation “Implementation of EAS/MEPRS Data Validation and Reconciliation,”and Reconciliation,” dated 21 Dec 99 and dated 21 Dec 99 and “MEPRS Early Warning and Control System,” “MEPRS Early Warning and Control System,” dated 28 May 02, along with the most current dated 28 May 02, along with the most current Service-Level Guidance: (C.1.)Service-Level Guidance: (C.1.)

– c) c) Were the data load status, Were the data load status, outlier/variance, WWR-EAS IV, and outlier/variance, WWR-EAS IV, and allocations tabs in the current MEWACS allocations tabs in the current MEWACS document reviewed and explanations document reviewed and explanations provided for flagged data anomalies?provided for flagged data anomalies?

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• Q. 4. Compliance with TMA or Q. 4. Compliance with TMA or Service-Level guidance for timely Service-Level guidance for timely submission of data (C.3.).submission of data (C.3.).

– a) MEPRS/EAS (45 days)a) MEPRS/EAS (45 days)

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TPOCSTPOCS• CHCSCHCS

– Duplicate RecordsDuplicate Records– Timely Data TransmittalTimely Data Transmittal

• Standard Inpatient Data Record (SIDR) Standard Inpatient Data Record (SIDR) • Worldwide Workload ReportWorldwide Workload Report

– Inpatient RecordsInpatient Records• AccountabilityAccountability• DocumentationDocumentation• CodingCoding• SIDRs completed (in a “D” status)SIDRs completed (in a “D” status)

– Workload ComparisonWorkload Comparison

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- b) SIDR/CHCS (5- b) SIDR/CHCS (5thth and 20 and 20thth calendar day of the month) calendar day of the month)

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- c) WWR/CHCS (10- c) WWR/CHCS (10thth calendar calendar day following month)day following month)

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• Q. 4. Compliance with TMA or Q. 4. Compliance with TMA or Service-Level guidance for timely Service-Level guidance for timely submission of data (C.3).submission of data (C.3).

– d) SADR/ADM (daily)d) SADR/ADM (daily)

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Data OutputData Output• A minimum of 30 records/encounters A minimum of 30 records/encounters

should be pulled randomly from the should be pulled randomly from the entire population of MTF inpatient entire population of MTF inpatient medical records for the audit data month.medical records for the audit data month.

• A random audit of 30 records per MTF A random audit of 30 records per MTF will provide a statistical confidence level will provide a statistical confidence level of 90%, with a confidence of 90%, with a confidence interval/sampling error range of plus or interval/sampling error range of plus or minus 15%.minus 15%.

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Data OutputData OutputInpatient CodingInpatient Coding

• CodingCoding– DRG Codes DRG Codes – Related Data Elements (C.5)Related Data Elements (C.5)

• All DiagnosesAll Diagnoses• Any ProceduresAny Procedures• SexSex• AgeAge• Discharge/DispositionDischarge/Disposition

• Percentage of SIDRs Completed (D-Percentage of SIDRs Completed (D-Status)Status)

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• Q. 5. Outcome of monthly inpatient Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h)coding audit: (C.5.c.f.g,h)

- a) Inpatient Records (DRG) # - a) Inpatient Records (DRG) #

Records Reviewed:_________ % Records Reviewed:_________ % Correct _______Correct _______

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• - b) Inpatient Professional Services - b) Inpatient Professional Services Rounds encounters E & M codes Rounds encounters E & M codes audited and deemed correct?audited and deemed correct?

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• - c) Inpatient Professional Services - c) Inpatient Professional Services Rounds encounters ICD-9 codes Rounds encounters ICD-9 codes audited and deemed correct?audited and deemed correct?

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• - d) Inpatient Professional Services - d) Inpatient Professional Services Rounds encounters CPT codes Rounds encounters CPT codes audited and deemed correct?audited and deemed correct?

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TPOCSTPOCS• ADMADM

– Timely Data TransmittalTimely Data Transmittal• Standard Ambulatory Data Record (SADR)Standard Ambulatory Data Record (SADR)

– Error LogsError Logs– Workload ComparisonWorkload Comparison

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Data OutputData OutputOutpatient CodingOutpatient Coding

• Sample SizeSample Size• AccountabilityAccountability

– Percentage Located or Properly Percentage Located or Properly Checked OutChecked Out

– Checked-out Over 30-Days?Checked-out Over 30-Days?• DD Form 2569 (Third Party DD Form 2569 (Third Party

Insurance Information)Insurance Information)

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• Q.6. Outpatient Records. Q.6. Outpatient Records. (c.6.a,b,c,d,e,f)(c.6.a,b,c,d,e,f)

– a) Is the documentation of the encounter a) Is the documentation of the encounter selected to be audited available? selected to be audited available? Documentation includes documentation Documentation includes documentation in medical record, loose (hard copy) in medical record, loose (hard copy) documentation or an electronic record of documentation or an electronic record of the encounter in AHLTA? the encounter in AHLTA?

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Data OutputData OutputOutpatient CodingOutpatient Coding

• E&M CodesE&M Codes• ICD-9 CodesICD-9 Codes• CPT CodesCPT Codes

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• Q. 6. Outpatient Records.Q. 6. Outpatient Records.

– b) What is the percentage of E & M b) What is the percentage of E & M codes deemed correct? (E & M code codes deemed correct? (E & M code must comply with current DoD must comply with current DoD guidance.) (C.7.(b))guidance.) (C.7.(b))

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– c) What is the percentage of ICD-9 c) What is the percentage of ICD-9 codes deemed correct? (C.6.(c))codes deemed correct? (C.6.(c))

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– d) What was the percentage of CPT d) What was the percentage of CPT codes deemed correct? (CPT code must codes deemed correct? (CPT code must comply with current DoD guidance.) comply with current DoD guidance.) (C.7.(d))(C.7.(d))

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– e) What percentage of completed & e) What percentage of completed & current (signed within the past 12 current (signed within the past 12 months) DD Form 2569s (TPC months) DD Form 2569s (TPC Insurance Info) are available for audit? Insurance Info) are available for audit? (C.7.(e))(C.7.(e))

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- f) What percentage of available, - f) What percentage of available, current and completed DD Form current and completed DD Form 2569s are verified to be correct in 2569s are verified to be correct in the Patient Insurance Information the Patient Insurance Information (PII) module in CHCS? (PII) module in CHCS?

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• Question 7 Ambulatory Procedure Question 7 Ambulatory Procedure Visits (C.7.a,c,d,e,f)Visits (C.7.a,c,d,e,f)

• Questions 7.a,c,d,e,f are the same as Questions 7.a,c,d,e,f are the same as Questions 6.a,c,d,e,f Questions 6.a,c,d,e,f

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• Q. 8. Comparison of reported workload Q. 8. Comparison of reported workload data (C.9).data (C.9).– a) # SADR Encounters / # WWR visitsa) # SADR Encounters / # WWR visits– b) # SIDR Dispositions / # WWR Dispositionsb) # SIDR Dispositions / # WWR Dispositions– c) # EAS Visits / # WWR Visitsc) # EAS Visits / # WWR Visits– d) # EAS Dispositions / # WWR Dispositionsd) # EAS Dispositions / # WWR Dispositions– e) # IPSR SADR encounters (FCC=A***)/# e) # IPSR SADR encounters (FCC=A***)/#

Sum WWR (Total Bed Days + Total Sum WWR (Total Bed Days + Total Dispositions)Dispositions)

Note: FY07 Goal is 80% Note: FY07 Goal is 80%

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Data OutputData OutputWorkload ComparisonWorkload Comparison

• SADR Encounters / WWR VisitsSADR Encounters / WWR Visits– Should Have More Encounters Than VisitsShould Have More Encounters Than Visits– Encounters – Omit Appt. Status of “No-Encounters – Omit Appt. Status of “No-

Shows,” “Canceled,” and Disposition Code Shows,” “Canceled,” and Disposition Code “Left Without Being Seen”“Left Without Being Seen”

– Encounters – Include Appt. Status Encounters – Include Appt. Status “TelCon”“TelCon”

– Only SADR Records Marked with an Appt. Only SADR Records Marked with an Appt. Status of “C” (complete) Are To Be Status of “C” (complete) Are To Be IncludedIncluded

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• SIDR Dispositions / WWR SIDR Dispositions / WWR DispositionsDispositions– Must MatchMust Match– Only SIDRs With a Disposition of Status Only SIDRs With a Disposition of Status

of “D” Are To Be Includedof “D” Are To Be Included– SIDRs – Exclude Carded for Record SIDRs – Exclude Carded for Record

Only (CRO) and Absent Sick RecordsOnly (CRO) and Absent Sick Records

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• EAS Visits / WWR VisitsEAS Visits / WWR Visits– Must MatchMust Match– Include MEPRS Functional Cost Code Include MEPRS Functional Cost Code

B** (Outpatient) and FBN (Hearing B** (Outpatient) and FBN (Hearing Conservation)Conservation)

– Include APVsInclude APVs

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• EAS Dispositions / WWR DispositionsEAS Dispositions / WWR Dispositions– Must MatchMust Match– Only SIDRs with a Disposition Status of Only SIDRs with a Disposition Status of

“D” are to be included“D” are to be included

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• IPSR encounters (FCC=A***)/# Sum IPSR encounters (FCC=A***)/# Sum WWR (Total Bed Days + Total WWR (Total Bed Days + Total Dispositions)Dispositions)

Note: FY07 Goal is 80% Note: FY07 Goal is 80% • Insure WWR calculation includes live Insure WWR calculation includes live

births (section 01) and Bassinet Days births (section 01) and Bassinet Days (section 00).(section 00).

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• Q.9. - System Design, Development, Q.9. - System Design, Development, Operations and Education/Training Operations and Education/Training (E.4.c).(E.4.c).

- # AHLTA SADR encounters/# of Total - # AHLTA SADR encounters/# of Total SADR encountersSADR encounters

Note: FY07 not scored. For management Note: FY07 not scored. For management use and tracking purposes only. use and tracking purposes only.

(* It is understood that not all clinical (* It is understood that not all clinical modules are deployed in the current modules are deployed in the current version of AHLTA.)version of AHLTA.)

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• Q. 10. – I am aware of data quality Q. 10. – I am aware of data quality issues identified by the DQMC issues identified by the DQMC Review List and when needed, have Review List and when needed, have taken action to improve the data taken action to improve the data from my facility.from my facility.

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SecuritySecurity• Responsibilities for computer security Responsibilities for computer security

formally assigned?formally assigned?• Is there a Security/Privacy Program in Is there a Security/Privacy Program in

place to address Security threats place to address Security threats (internal/external) and HIPAA Compliance(internal/external) and HIPAA Compliance– Password Protection?Password Protection?– Access to systems?Access to systems?– Confidentiality of data?Confidentiality of data?– Level of Access to MEPRS/EASi, CHCS, Level of Access to MEPRS/EASi, CHCS,

AHLTA, ADM, TPOCS, CCE, DMHRSiAHLTA, ADM, TPOCS, CCE, DMHRSi

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System Design, Operations, System Design, Operations, and Education/Trainingand Education/Training

• System Administrator Appointed In System Administrator Appointed In Writing for Each SystemWriting for Each System

• Training and Education Procedures and Training and Education Procedures and DocumentationDocumentation

• System Change Request ProcessSystem Change Request Process• System Incident ReportSystem Incident Report• Routine MaintenanceRoutine Maintenance• Points of Contact for Equipment Failure Points of Contact for Equipment Failure

IssuesIssues• Contingency PlansContingency Plans

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Data Quality Section, Data Quality Section, PASBAPASBA

Mr. Joseph (Tim) Bacon (Chief DQ Section, PASBA / Army DQ Mgr)Telephone: (210) 295-8725 DSN: 421

Ms. Deborah Lundberg (NARMC)(210) 295-8923 DSN: 421

Mr. Angel Padilla (18th MEDCOM/PRMC/WRMC)(210) 295-8842 DSN: 421

Mr. Joe Alley (ERMC/SERMC)(210) 221-0467 DSN: 421

Ms. Vicki Vestal (GPRMC)(210) 295-8931 DSN: 421

1 data quality management control program army – mr. angel padilla

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