excellent healthcare, clinical currency air force medical operations agency 2012 tma dq course 1...

Excellent Healthcare, Clinical Currency

Air Force Medical Operations Agency

2012 TMA DQ Course

1

AFMOA/SGAR

Current as of 10 May 2012


Air Force TMA DQ Course Break-Out Session Overview

Organization

Why Data Quality?

MTF Engagement

Guidance

DQ Assurance Team

CHCS Provider File

Metrics

Other DQ Efforts

DQ Review List/Statement Guidance & Completion

eDQ

2


ORGANIZATION

3

Excellent Healthcare, Clinical Currency 4

Organization

AFMOA (Execution)

Chief, Financial Performance Data Quality Program Manager

AF Data Quality Manager Program Analyst

Data Quality SME/DBA

Data Quality SME

HAF/SG8Y (Policy)


Organization

5

SGA

SGAIInfo Services

SGALMed Logistics

SGAPManpower

SGARResource Mgt

SGATHealth Benefits

SGAX**Readiness

MEPRS DQ UBO


Readiness

AFMOA Strategic Alignment

6

GoalsRebuild inpatient

platforms to provide clinical

currency needed for readiness,

GME and warrior care

Medical Home to provide efficient, patient centered

health care

Sustain clinical currency for

readiness beyond what our

platforms can provide

Standard processes where

needed to improve quality

and reduce waste

VisionWorld-class healthcare for our beneficiaries anywhere, anytime

Mission

Support development and oversee execution of Air Force Surgeon General Policies


Provide Comprehensive DQ Program Management to all AF MTFs

Provide reach-back support to MAJCOMs and DRUs

Our Mission

7

AFMOA Data

Quality

Air Force MTFs

DRUs

MAJCOMS

Standardize methodologyEvaluate processesReduce variance


DQ Program Manager

DQ Program Analyst DQ DBA/SME 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, etc.) - Create CHCS restrictions/business rules to promote

standardization- Develop CHCS training guides to promote MTF DQ - Provide Ad Hoc report assistance to support MTF’s - Perform MTF site visits to provide on-site technical

assistance- Manage performance metrics to validate improvement

efforts Mission: - Provide Comprehensive DQ

- Program Management to all MTFs

- Provide reachback support to MAJCOMs and DRUs

Key Objectives:- Standardize Methodology- Evaluate Processes- Reduce Variance

Future Initiatives:- Consolidation - Shape MHS/AFMS DQ

efforts


WHY DATA QUALITY?

9


Data Quality Integrated Approach

10

MEPRSPersonnel

Workload

Financial

UBOOther Health

Insurance

Eligibility

Demographics

CodingSIDR/SADR

MSDRG/RWP

RVU/CPT

Patient

&

Provider

Completeness

Timeliness

Accur

acy

Data Quality


Why is Data Quality Important?

Monitor efficiency of the healthcare system

Prospective Payment System (PPS)

Base Realignment And Closure (BRAC)

Medicare Eligible Retiree Health Care Fund (MERHCF)

MTF Business Plans

Provider/Clinic Workload Productivity

Reimbursements (TPC, Coast Guard, NOAA…etc)

Enable the Leadership to make informed decisions

11

For these reasons, it is vital your data accurately reflect work performed in your MTF!


What could go wrong?

12

Air Force

MDR

M2

WWR(Count Visits)

EAS IV“Eligible” EncountersCPT Codes Units of Service

WAMCount Visits & Raw Services

SADRCAPER(Encounters)

TPOCSBillableEncounters

PDTS

Worldwide Workload Report

Standard Ambulatory Data Record

EAS Repository

EAS IVExtract

MHS Data Repository

MHS Mart

Service Repository (BDQAS)

Pharmacy Data Transaction System

Pop HealthPortal

CCE

Coding Compliance Editor

ClinicalData Mart

TRICAREOps Center

Interface Errors

DoD/VA FHIE/BHIE SHARE

ADMSADR 1/SADR 2

Essentris

CCQAS


MTF ENGAGEMENT

13


MTF DQ Engagement

One-on-One Support

Telephone and E-mail: [email protected]

Defense Connect Online (DCO) & optimize use of Vector Check

MTF-AMFOA DQ Teleconferences Every Other Month PACAF, CONUS, USAFE (schedule on Vector Check) DCO used to conduct meetings and take attendance Business and training conducted at each meeting

Site Visits

AF portion of the TMA DQ Course

Other Conferences/Forums

14


Defense Connect Online

To become a registered user visit: https://www.dco.dod.mil

Link to meeting will be sent via email/calendar request

Share screen capability to maximize training

Chat capabilities to ask questions to all or individuals


Vector CheckYour DQ Toolkit

Announcements

Calendar

Contacts

FAQs

Documents

Electronic Data Quality Application (eDQ)

Subscribe to Alerts!

16


Vector CheckGaining Access

17

Your Vector Check account is linked to your Knowledge Exchange (Kx) account

If you don’t have a Kx account, create one at https://kx.afms.mil Click:

If you have a Kx account, verify your e-mail address is correct (then WAIT 24 Hrs prior to signing into Vector Check). Click:


Vector CheckGaining Access

18

After you have been granted a Kx account (this may take up to 24 hours), navigate to Vector Check at: https://vc.afms.mil

The first time you visit the Vector Check site, you will be redirected to a registration page. The form will be pre-populated. Verify and submit the information.


Vector CheckUpdating the RM Master Roster

Update your POC information on the RM Master Roster at: https://vc.afms.mil/AFMOA/SGA/SGAR/Lists/Resource%20Management%20Master%20Roster%20Updates/Summary%20View.aspx

Select “New” to add a new POC, or select “Actions / Edit in Datasheet” to edit POCs. The contact information for these positions must always be kept current: MDG CC MDG Deputy CC MDSS Commander Administrator RMO RMO NCOIC DQ Manager DQ Alternate

19


Vector Check DocumentsTraining Material on VC

Review training materials posted on Vector Check “Alerts, Timeliness and Accuracy, and TUG”

Pathway: Vector Check > AFMOA > SGA > SGAR > SGAR – Data Quality > Documents > Training > Administrative

All DQ Review List and Statement Training Slides Pathway: Vector Check > AFMOA > SGA > SGAR > SGAR –

Data Quality > Documents > Training > DQ Review List and Statement Training Slides

Review the latest DQ Teleconference Notes Pathway: Vector Check > AFMOA > SGA > SGAR > SGAR –

Data Quality > Documents > Data Quality Meeting Minutes-Notes

20


GUIDANCE

21


Overview

DoDI 6040.40 DQ Mgmt Control (DQMC)

Procedures DQMC Review List Data Quality Statement Annual Updates – TMA Led Recommends Data Quality

Assurance Team (DQAT) Composition

22


Health Services Inspection (HSI)

2012 HSI Checklist, OM.3.2.2

The Data Quality Assurance Team (DQAT) met monthly: Completed DQMC Review List Briefed Executive Committee

on all Review List performance that was not compliant

There was evidence corrective action plans were created, monitored and progressing to address non-compliant or underperforming DQMC items


Health Services Inspection (HSI)

2012 HSI Checklist, OM.3.2.2

Documents Required for Review:

Current and past year’s

DQM reports

DQAT meeting minutes


DQ ASSURANCE TEAM

25


DQ Assurance Team

The Data Quality Assurance Team (DQAT) or other designated structure met during the reporting month to complete the DQMC Review List.

26

DoDI 6040.40 Recommended Team Composition:

• DQ Manager• Directors of Clinical Activities• MEPRS/EAS Coordinator• Budget/Accounting• Medical CIO• Health Information Manager• CHCS Administrator• Group Practice Managers• Patient Administration

Additional team members recommended in Data Quality Team User’s Guide:

• Coder/coding auditor• AHLTA Trainer• Ancillary services representative• Defense Medical Human Resources

System – internet (DMHRSi) personnel (i.e., DMHRSi Manager, contract liaison, civilian liaison, volunteer liaison, and Command Support Staff (CSS) personnel)

• UBO Manager• Clinic support staff representative• Resource Management Flight CC

Red indicates required members when AFI 41-120 is published


DQ Assurance Team

• Provider file clean-up and maintenance• TMA coding audit• MEPRS ASD reconciliation• DMHRSi program• DD Form 2569 collection process

Provide oversight for:

Develop DQ initiatives

• Ensure there is cross-talk• Recommend at your next DQ meeting, that everyone goes around the room and

understands why they are a member of the team• What role they have in DQ• What ideas they have to make the team (ultimately your MTF) better

Communication:

• File/Table updates, Clinic/Provider profiles• Appointment standardization

Proper CHCS File/Table set up

• Account Subset Definition (ASD) Table Reconciliation• Inappropriate MEPRS Codes

Assigning Workload to the Proper MEPRS/FCC Codes


DQ Assurance TeamInitiatives - Interest Items (cont)

• Verify Eligibility in DEERS• Gather/Verify Demographics and OHI

Patient Registration/Admissions/Front Desk Duties

• Documentation must record what actually occurred• Ensure Accuracy/Completeness• TMA Annual Coding Audit tracking

Coding

Patient safety

CHCS Training

Accountability

• Include critical data elements• Correct critical data elements

Improve data accuracy

Capture workload and revenue opportunities


CHCS PROVIDER FILE

29


CHCS Provider File Report Cards

30

IMPACT76% decrease in the number of Provider File errors across AFMS since Nov 09

ACTIONS

Centrally produced MTF report cards; refined focused approach

Created a library of training materials to correct backlog

and prevent errors

Partnered with Pharmacy community (point of entry

for most external providers) to focus on prevention

Conducted Focus site visits to provide training and

obtain buy-in

ISSUES

Impacts REVENUE, WORKLOAD, PATIENT SAFETY and DATA INTEGRITY

Lack of expertise, ownership and guidance to resolve and prevent provider file errors

PROCESS

Eliminate CHCS Provider File error backlog and prevent future errors across AFMS


Primary Effects of CHCS Provider File Errors

Revenue

Patient Safety

Data Integrity

Workload

31


CHCS Provider FileContinuity Guide

32

• Comprehensive reference for issues related to CHCS provider file maintenance

• Nearing completion – release date TBD

• Includes step-by-step guidance to correct errors

• Recommendations for provider file management

• Includes helpful resources


Provider File Report Card

33


Provider Details Report

34


Outside Provider Entry Checklist

35


METRICS

36


DQ Performance Metrics

37

https://vc.afms.mil/AFMOA/Matrix/default.aspx


DQ Performance Metrics

38

http://www.tricare.mil/ocfo/mcfs/dqmcp/metrics_reports.cfm

https://vc.afms.mil/AFMOA/SGA/SGAR/SGARDQ/Documents/Forms/AllItems.aspx


AF DQResults

39


DQ Statement Signed by?

42


Provider File Progress Metrics

43


Workload Guidelines Sample

- Supplements AF Coding Guidelines- Published by AF Coding Experts- MHS Coding Guidelines, inpatient and outpatient, dated 1 January

2011http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm

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*** B*** Count Registered dieticians or licensed nutrition Professionals are responsible for providing medical nutrition therapy (MNT).

Yes Yes


OTHER DQ EFFORTS

45


Support Provided

Correct CHCS patient registration errors for all Air Force MTFs

Primary Care Manager Information Transfer (PIT) Errors

Correct Patient Registration Errors (FY11-558K Patients)

Merge CHCS Duplicate Patients

Identify AHLTA Multiples and Log MHS tickets

Subject Matter Expertise Support

Partner with DoD to develop policies and processes to reduce patient registration errors

Identify and correct systemic issues, which contribute to the duplication of clinical records and put patient safety at risk

AFMS Record Reconciliation Initiative


Support Provided

47

Training

Conduct Pt Reg, PIT Error, Duplicate Patient training at MTFs, Conferences, DCO Connect, etc.

Phone consultations as needed

Enterprise Health Data Optimization System (eHDOS) Reports

Summary Reports by MAJCOM and MTFs on Vector Check

Users with Registration Capability

Number of New Patients Added to CHCS with Critical Errors

Number of Potential CHCS Duplicate Patients

Number of Patients with Patient Category Mismatches

Number of PIT Errors

Managed Care File/Table Concerns Affecting PIT Errors


AFMOA Data Quality Vector Check

48

MTF Reports are posted to the AFMOA Data Quality Vector Check monthly

Menu path: Vector Check-AFMOA-SGA-SGAR-Data Quality-Documents-Patient Registration MAJCOM_MTF Reports


AFMOA Vector Check-The MATRIX

49


DQ REVIEW LIST/STATEMENT GUIDANCE & COMPLETION

50


TUG

51

Primary AF-specific DQ guidance

Clarifies questions on the DQMC Review List

Includes formulas, background information, and how to get the data

Available on Vector Check

Share with the DQAT

Discuss at your DQ meeting to ensure it is read and understood by those answering DQ statement and review list question

Organization mirrors the review list

Updated during the year as needed


TUG: Six Linked Worksheets

52

Click the options box and select "enable this content"

Tab 1: Forward

Tab 2: TUG Contents Filtered & Linked

Tab 3: TUG

Tab 4: TUG Appendix

Tab 5: DQ Review List

Tab 6: DQ Statement


TUG Contents

The following is provided for each review list and statement question:

Performance threshold

Calculation (if applicable)

Details (may include “step-by-step” guidance)

Process

Additional Information

53


DQ Review List/StatementReminders

Refining/expanding beyond DQ statement…TUG

Internal tool to assist in identifying & correcting financial & clinical workload data problems

DQMC Review List requires all supporting summary documentation kept on file for 5 years

Monthly Requirement

All variances on the REVIEW LIST should be briefed with DQ Team and Executive Committee

MTFs need back up plans for Data Quality and all other areas that support completing the Review List

eDQ is based on the Review List

54


DQ Statement Due Date

25th

DUE THE LAST DUTY DAY OF THE MONTH

Day One – Notify RMO

Day Two – Notify MDSS/CC

Day Three – Notify MDG/CC

Aggressive follow up if late:


DQ Review List Comments

Evaluate all comments non-compliant Review comments to ensure complete and concise Problem, corrective action plan, ECD required Do not use “I”, “AFMOA”, “John Doe”, etc… Do use functional area, ie. DQ Manager, Coding Auditor,

AFMOA Coding… If stating contractor, system or AFMOA has impacted a metric

negatively, require back up documentation These comments will be validated before approved

Review comments with Contracting Officer Representative (COR) (if comment provided by contractor) for comments requiring further clarification

Comments included on your MTF Statement are posted word for word on TMA and vector check websites

56


DQ Review List DQ Assurance Team Meeting

Question A.3: The DQ Assurance Team or other designated structure met during the month to complete the DQ Management Control Review List (recommend attaching meeting minutes)

Date Completed: __________

Data Month: ______________

YesNo

(comment required)

N/A(not appropriate for this

question)


DQ Review List DQ Assurance Team Meeting

Question A.4: The DQ Manager briefed last month’s Data Quality Management Control Review List, and Financial and Workload Data Reconciliation and Validation results to the MTF Executive Committee

YesNo

(comment required)


question)


DQ Review List TMA DQ Course

Question A.7a: TMA Data Quality Course (DQ Manager in the last three years)?

YesNo

(comment required)


question)

Recommend using the A.7 a-c to highlight training needs to your MTFs leadership


DQ Review List Negative Findings

Question A.8: Was there evidence in meeting minutes or other sources of corrective plans, of appropriate resourcing and actions to follow-up on the previous month's negative findings?

YesNo

(comment required)


question)


DQ Review List Rejected Data

Question B.4: Were all rejected data corrected and retransmitted? (As applicable.)

YesNo

(comment required)

N/A(Only use when no rejected data needed to be corrected

or retransmitted)

h) TPOCS – File Upload Status Report

g) MEPRS (EAS) - Error Correction Unit

e) DMHRSi - 100% Timecards approved?

d) CHCS - PIT Errors

c) CCE - ADM SADR/TPOCS Extract Status Display & CCE Interface Error Report

b) AHLTA - AHLTA ADM Exceptions Report

a) ADM - ADM SADR CAPER Error Report


DQ Review List/StatementEnd of Day

Question B.5.a. (DQ Statement question 1a): 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?”

Source: BDQAS

≥ 97% ≥ 80% but < 97%(comment required)

< 80%(comment required)

Number of closed CHCS appointments

Total CHCS appointments for the month


BDQAS

Biometric Data Quality Assurance Service (BDQAS) is a source for many DQ statement questions (https://bdqas.afms.mil/)

Updated on the 10th or 11th for non-EAS data

EAS data on BDQAS is updated between the 16th and 20th

If EAS transmission did not occur on-time, questions that are applicable to EAS must be manually calculated and annotated on the review list

63


BDQAS

DQ Review List / Statement Report data is found here:https://bdqas.afms.mil/data_metrics/data_metrics.htm

Metrics you can drill down to clinic level and get AFMS rankings


DQ Review List Monthly Statistical Report

Question B.5.c: Were all workload discrepancies on the CHCS Monthly Statistical Report corrected prior to processing the WWR and WAM files?

YesNo

(comment required)


question)

MINI_CAPER_DQ adhoc – Use frequently throughout the month to encourage correcting workload in a timely manner


MINI CAPER DQ REPORT

Designed to help Medical Treatment Facilities (MTFs) identify and correct patient appointment workload discrepancies prior to running the MSR

Some examples on how to utilize report: Appts Closed at EOD (B.5.a) Workload Count By Provider Type (B.5.c) Ensuring Providers Sign T-cons and Encounters on Time (B.6.a) Determining whether the “ADMIN” status is properly utilized

(B.5.d) Report generates a significant amount of appointment data, it can

also be used for statistical analysis.


DQ Review List ADMIN Closed

Question B.5.d: Do you have a process or policy in place to ensure the appropriate use of using "admin" when closing encounters in CHCS?

NOTE: Administratively closing an appointment is as if the appointment never existed. "Admin" should be used for one of the following reasons: Training and Testing purposes Duplicate encounters Appointment created in error

YesNo

(comment required)


question)

# of admin closed appointments: ______


DQ Review List/StatementOutpatient Timeliness

Question B.6.a (DQ Statement question 2a): What percentage of Outpatient Encounters, other than APVs, has been coded within 3 business days of the encounter?

Source: BDQAS



Sum of Non-APV CAPER Encounters Coded W/in 3 Business Days

Sum of Non-APV Daily Outpatient Workload Reports (DOWR)

Nurses and Techs with “count” encounters will negatively impact metric; FY12 data has 32K encounters with incorrect workload


DQ Review List/StatementAPV Timeliness

Question B.6.b (DQ Statement question 2b): What percentage of APVs have been coded within 15 days of the encounter?

Source: BDQAS If non-compliant, a time study is required each month until

compliant Where are your delays?

Transcription

Records

Provider

Coder



Sum of APV CAPERs Coded W/in 15 Calendar Days Sum of APV DOWR


DQ Review List/StatementInpatient Timeliness

Question B.6.c (DQ Statement question 2c): What percentage of Inpatient records have been coded within 30 days after discharge?

Source: Run “Inpatient Timeliness” ad hoc found on BDQAS

If the MTF lacks a coder, the numerator will be “0” and the denominator will be taken from the WWR Total Dispositions



Total # of Records CodedWWR Total Dispositions


DQ Review ListCCE

B.7.a: What percentage of encounters had an encounter coding status of “Completed” for the data month?

Source: CCE



This question measures CCE utilization. Due to the AF coding model, AF MTFs will have a low percentage for this question.

Denominator

Numerator


DQ Review List/StatementReconciliation

Question C.1.a (DQ Statement question 3a): Was the monthly MEPRS (EAS) financial reconciliation process completed, validated and approved by the MTF Resource Manager (i.e., AF Budget Officer or Analyst prior to MEPRS monthly transmission?

Source: MEPRS Manager and RMO Office

EAS Transmission does not impact this question.

YesNo

(comment required)


question)


DQ Review List/StatementReconciliation

Question C.1.b: Has the MTF used the Workload Generation Controller (WGC) in CHCS to generate their WWR and WAM files?

Source: MEPRS Manager

YesNo

(comment required)


question)

WGC process is an 11 step process


DQ Review List/StatementMEWACS

C.1.d. (DQ Statement question 3b): 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?


C.1.d.1 through C.1.d.4 must be answered

If you reviewed tabs on MEWACS, C.1.d.1 - C.1.d.4, regardless of anomalies, ANSWER YES

YesNo

(comment required)


question)


MEWACS:http://www.meprs.info

Will be required to register to access


Select:Data Load StatusSummary OutliersWWR/EAS IV OutliersAllocation Test


AFMOA MEPRS Dashboard

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


AFMOA MEPRS Dashboard Nellis AFB, Nov 2009

Validated

Error

Error

Error Error

Error

Errors

Research


AFMOA MEPRS Dashboard Nellis AFB, Apr 2010

Research

Corrections Pending

Corrected Corrected

Corrected

CorrectedCorrected

Validated

Research


C.1.f. (DQ Statement question 3c): For DMHRSi, what is the percentage of submitted timecards by the suspense date?

=100%< 100%

(comment required)

C.1.g (DQ Statement question 3d): For DMHRSi, what is the percentage of approved timecards by the suspense date?

DQ Review List/StatementTimecards

Number of Timecards Submitted On-time Total Number of Timecards for an MTF

Source is MEPRS Manager

Number of Timecards Approved On-time Total Number of Timecards for an MTF


C.1.f. (DQ Statement question 3c) For DMHRSi, what is the percentage of submitted timecards by the suspense date? Source is MEPRS Manager?

Number of Timecards Submitted On-time

315

320Total Number of Timecards for an MTF

Denominators (bottom numbers) should be the same

Remove the following statuses NULL NOT SUBMITTED REJECTED WORKING

Remove all personnel who did not work during pay period

C.1.g. (DQ Statement question 3d) For DMHRSi, what is the percentage of approved timecards by the suspense date? Source is MEPRS Manager

Number of Timecards Approved On-time

310

320Total Number of Timecards for an MTF

Cannot be greater than C.1.e.

Remove the following statuses NULL NOT SUBMITTED REJECTED WORKING SUBMITTED

Remove all personnel who did not work during pay period

Remember, comments are required if under 100%




Timecard compliance and EAS transmission

Pay period ends

Timeliness Timecard submission

Timeliness Timecard approval

Member PCS’d

Rejected timecards corrected

DQ Statements due to AFMOA



Timecard compliance and EAS transmission

Pay period ends

Timeliness Timecard submission

Timeliness Timecard approval

Rejected timecards corrected

DQ Statements due to AFMOA


DQ Review List/StatementCHCS Duplicate Patients

Question C.2. a. (DQ Statement question 10) Use CHCS during the data month to identify duplicate patient registration. For CHCS or AHLTA hosts only, what was the number of potential duplicate patient registration in the data month for all MTFs under the host? (NOTE: Only Host sites report up.)

Source is Internal Process

Report RanReport Not Ran

(comment required)If you are not a host site,

LEAVE BLANK

Run the CHCS standard report – “Potential Duplicate Patient Search”


Run Time Statistical Report Validate the accuracy of the potential duplicate patients being

reported Provide Summary Documentation (5 year requirement) Detailed Results w/out Protected Health Information (PHI) Identifies if Potential Duplicate’s are resolved

The sum of these 4 columns is the potential duplicate number reported on the DQ Statement



Total # of potential duplicate patients

Must add up to the total listed above

Pre-populated with DMIS ID(s) and MTF(s) associated with host site



89

Potential Duplicate Report

Run the Registration report

Run for the entire data month

Run this report no earlier than the first day after the data month

Identify, Exclude, and/or Merge potential duplicates

Provide DQ Manager the potential duplicate number(s) by unresolved, identified, excluded, and merged

Run Time Statistical Report

Use this report as summary documentation

Provides results of the Potential Duplicate Report

Run this report for the first day after the data month to present

This report captures WHEN the potential duplicate report was ran and the results

The numbers in the unresolved, identified, excluded, and merged columns are all to be reported on the DQMC Review List & Statement



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

90

Patient Duplicate Reporting


DQ Review List/StatementEAS Transmission

Question C.3.a (DQ Statement question 4a): MEPRS/EAS (45 days)


EAS transmission should not occur until 100% timecard compliance is achieved, per AF/SG policy letter

YesNo

(comment required)


question)


MEPRS Transmission (C.3.a)

Request summary documentation of timely submission Email is generated when MEPRS Transmission occurred Ensure transmission occurred on or before the 45th calendar

day after the data month

When reviewing BDQAS data, if the numerator for C.9.c is not available, MEPRS Transmission was not timely

92


DQ Review List ADM SADR/CAPER Errors

Question C.4.a: Check the ADM SADR/CAPER Error Report?

YesNo

(comment required)


question)

Question C.4.b: Correct the errors listed on the report?


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:# of correct ICD-9 codes

Total # of ICD-9 codes

E&M: # of correct E&M codes

Total # of E&M codes

CPT: # of correct CPT codes

Total # of CPT codes

*Note: The denominator for all categories should include codes identified by the auditor.*Note: If your MTF doe not have a coder; the numerator will be 0 and the denominator will be 30

*Note[p1] : The denominator for all categories should include codes identified by the auditor. [p1]#134, 135, 136

The Service Headquarters will determine the specific random sample to be audited.


Inpatient Coding/Rounds

Must audit a minimum of 30 records

95

Question # Numerator Denominator %

5a(MS-DRG)

Medical Severity

Diagnosis Related Group

30 30 100%

5b (E&M)Evaluation & Management

29 30 97%

5c (ICD-9)Diagnosis

25 25 100%

5d (CPT)Procedure

35 40 88%

MS-DRG and E&M denominators must

No good indicator for CPT

Expect ICD-9 codes to be higher


Availability (Outpt/APV)

If the documentation is available; however, the patient’s outpatient health record is not available, the “record of the encounter” is available for audit

Calculated from the records audited by coding auditor

96

Availability and E&M denominators should match or be close

No good indicator for CPT

Expect ICD-9 codes to be higher than E&M


DQ Review List/Statement DD Form 2569 Availability

Question C.8. (DQ Statement questions 8a (Inpatient), 8c (Outpatient), 8e (APVs)): What percentage of completed and current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) are available for audit?

Source: UBO Manager

Number of Complete and Current DD Form 2569s Available

Number of Non-Active Duty Records available from Audit



If you do not have a coding auditor, an alternate method is provided in the TUG


Roles and Responsibilities2569 Pull List/Audit

Coding Auditor - COPY and PASTE the encounters from CARS then paste in a word document in a landscape format

UBO Manager - Exclude all the active duty member’s and audit ALL non-active duty members Do not alter list Auditing only 30 is not

acceptable

DQ Manager - Provide a listing of non-active duty members to UBO Manager using alternate method only when there is not a coding auditor

98


2569 DQ Review List/Statement Questions

C.8.c. What percentage of completed and current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) is available for audit (non-active duty encounters only)?

Number of complete and Current DD Form 2569s Available

95

100Number of Non-Active Duty Non-APV

Records Available from Audit

Searching for a patients 2569 information in Mini Registration is incorrect and should not be used to conduct the audit

C.8.d. What percentage of available, current and complete DD Form 2569s is verified to be correct in the Patient Insurance Information (PII) module in CHCS?

Number of DD Form 2569s Correct in PII Module in CHCS

93

95Number of Available, Current and Complete

Non Active Duty DD Form 2569s available from the Outpatient – Non APV 2569 Audit

The numerator in C.8.c. becomes your denominator in question C.8.d.


DQ Review List/Statement Workload

C.9.c. (DQ Statement question 9c): Comparison of reported workload data.

Number of MEPRS visitsNumber of Kept Appts (count only)

≥ 95%≥ 80% but ≤ 95% or

≥ 105%(comment required)


Source: BDQAS

If EAS was not transmitted on-time, manually calculate numerator


DQ Review List/Statement Rounds

Question C.5.f-h (DQ Statement questions 5b-d): Coding Accuracy of Rounds

Question C.9.e (DQ Statement question 9e): Comparison of reported workload data

Source: M2 and WWR

Number of “A***” CAPERS completed by attending provider or service (FCC=A***)

Number of Sum WWR (Bed Days + Bassinet Days + Dispositions)

≥ 95% ≥ 80% but < 95% < 80%

≥ 80% ≥ 110% < 80%

Questions C.5.f-h

Question C.9.e


Rounding

102

Per AF DQ TUG: Percentages must be reported to one decimal point. Rounding of actual performance calculations beyond one decimal point is prohibited.

This means if percentage is 94.9% for the questions where compliance is 95%, a comment will be required and question is non-compliant


EDQ

103


eDQ Documents

104

Vector Check URL: https://vc.afms.mil


eDQ Documents


eDQ Availability


Comments & Space Limitations

Limited to 1,000 Characters




Take Aways

Data Quality is much more than the DQ Statement

Data must be:

Front-end processes are CRITICAL to back-end success

ANALYSIS OF DATA

DMHRSiENGAGED DQ TEAM

PROVIDER F

ILE

ASD RECONCILIATION

2569 COLLECTION

APPT STANDARDIZATION

BUSINESS PLANS

CODING

CAPERS

ADM

END OF DAY

AND MUCH, MUCH MORE!


Group Email Box: [email protected]

109

AFMOA DQ Point of Contacts


Summary

110

Organization

Why Data Quality?

MTF Engagement

Guidance

DQ Assurance Team

CHCS Provider File

Metrics

Other DQ Efforts

DQ Review List/Statement Guidance & Completion

eDQ


Questions?

Data Quality Program Office

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Documents

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