Air Force TMA DQ Course Break-Out Session

1. Air Force TMA DQ Course Break-Out Session AFMOA/SGAR May 10

2. 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

3. 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

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

5. Data Quality (DQ) Roles and Responsibilities DQ Program Manager DQ Program Analyst DQ SME DQ SME • 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 • 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 • 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 • Field Electronic DQ Statement

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

8. 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.

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. 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\

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19. What is available on Vector Check?

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

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

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

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

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. 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

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

30. Workload Guidelines Sample • Supplements AF Coding Guidelines • Published by AF Coding Experts https://kx.afms.mil/kxweb/dotmil/file/web/ctb_098772.pdf

31. 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. 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. DQ Assurance TeamInitiatives - 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

34. DQ Assurance TeamInitiatives - 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. 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. 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. CHCS Provider File Errors and Error Criteria

38. CHCS Provider File Errors and Error Criteria (cont)

39. 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

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 Facility 700 • Small Facility 300 • Average Amount Billed per claim: $50 • If your provider file has 100 outside providers that issued at least one script per month with missing data in their profile: provider specialty codes, NPI (new requirement mid FY08), DEA #, provider name and ID. • Potential Loss is $5,000 in billable claims per month • Potential Loss is $60,000 in billable claims per year

41. Volume and error types will dictate cleanup strategies Monthly error rates for the MTF

42. Provider Report Card(continued – page 2) Peer Group Comparison

43. Provider Details Report

44. AFMOA DQ Provider File Roles/Responsibilities

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. MTF DQ Team Provider File Roles/Responsibilities

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. Other Data Quality Efforts All CHCS Files Patient File Related

49. Patient Registration DQ Team

50. Patient Registration DQ Team (cont)