Data Quality Management Control Program

Data Quality Management Control Program Data Quality Section, PASBA

Overview • Patient Records Accountability • Coding Audits • Sampling Size and Techniques • Inpatient Records • Outpatient Records • Workload Comparison • System Security • System Design, Development, Operations, and Education and Training • Regulatory Guidance • Program Management • Organizational Factors • System Inputs, • Processes, and Outputs • CHCS • ADM • MEPRS/EAS • TPOCS • MEWACS

Regulatory GuidanceDODI 6040.40Military Health System Data Quality Management Control Procedures

Regulatory GuidanceDODD 6040.41Medical Records Retention and Coding at Military Treatment Facilities

Regulatory GuidanceDODD 6040.42Medical Encounter and Coding at Military Treatment Facilities

Regulatory GuidanceDODD 6040.43Custody and Control of Outpatient Medical Records

Program Management • Data Quality Manager • Data Quality Assurance Team • Intermediate Command DQ Manager • Service Data Quality Manager • DQMC Review List • Commanders Monthly Data Quality Statement (internet based)

System Inputs, Processes, and Outputs • Composite Health Care System (CHCS) • Armed Forces Health Longitudinal Technology Application (AHLTA) • Ambulatory Data Module (ADM) • Medical Expense and Performance Reporting System (MEPRS) / Expense Assignment System (EAS) • MEPRS Early Warning and Control System (MEWACS) • Defense Medical Human Resources System –Internet (DMHRS-i) • Third Party Outpatient Collection System (TPOCS)

Data InputMEPRS/EAS, ADM, CHCS, TPOCS • Written Procedures • Current Versions • Upgrades & Updates • Rejected Records • End of Day Processing • Percentage of Clinics • Percentage of Appointments • Timely Coding Completion

Commander’sData Quality Statement • Q. 1. What percentage of appointments was closed in meeting your “End of Day” processing requirements, “Every appointment – Every day?” (B.5.)

Commander’sData Quality Statement • Q. 2. In accordance with legal and medical coding practices, have all of the following occurred: • a) What percentage of Outpatient Encounters, other than APVs, have been coded within 3 business days of the encounter? (B.6.(a)) • b) What percentage of APVs have been coded within 15 days of the encounter? (B.6.(b)) • c) What percentage of Inpatient records have been coded within 30 days after discharge? (B.6.(c))

Data OutputMEPRS/EAS, ADM, CHCS, TPOCS • EAS • Financial Reconciliation • Inpatient and Outpatient Workload Reconciliations • MEWACS Review • Timely Data Transmittal • Workload Comparison

Commander’sData Quality Statement • Q. 3. Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities Manual (MEPRS Manual) DoD6010-13-M, dated April 7, 2008, paragraph C3.3.4, requires report reconciliation (C.1.) • a) Was monthly MEPRS/EAS financial reconciliation process completed, validated and approved prior to monthly MEPRS transmission?

Commander’sData Quality Statement • Q. 3. Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities Manual (MEPRS Manual) DoD6010-13-M, dated April 7, 2008, paragraph C3.3.4, requires report reconciliation (C.1.) • b) Were the data load status, outlier/variance, WWR-EAS IV, and allocations tabs in the MEWACS document reviewed and explanations provided for flagged data anomalies?

Commander’sData Quality Statement • Q. 3. Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities Manual (MEPRS Manual) DoD6010-13-M, dated April 7, 2008, paragraph C3.3.4, requires report reconciliation (C.1.) • c) For DMHRS-i, what is the percentage of timecards submitted by the suspense date? • d) For DMHRS-I, what is the percentage of approved timecards by the suspense date?

Data OutputMEPRS/EAS, ADM, CHCS, TPOCS • CHCS • Duplicate Records • Timely Data Transmittal • Standard Inpatient Data Record (SIDR) • Worldwide Workload Report • Inpatient Records • Accountability • Documentation • Coding • SIDRs completed (in a “D” status) • Workload Comparison

Commander’sData Quality Statement • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.). • a) MEPRS/EAS (45 calendar days)

Commander’sData Quality Statement • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.). - b) SIDR/CHCS (5th and 20th calendar day of the month)

Commander’sData Quality Statement • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.). - c) WWR/CHCS (10th calendar day following month)

Commander’sData Quality Statement • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3). • d) SADR/ADM (daily)

Data Output • A minimum of 30 records/encounters should be pulled randomly from the entire population of MTF inpatient medical records for the audit data month. • A random audit of 30 records per MTF will provide a statistical confidence level of 90%, with a confidence interval/sampling error range of plus or minus 15%. • The PASBA is generating a monthly DD Form 2569 audit pull-list for auditing of other health insurance .

Data OutputInpatient Coding • Coding • DRG Codes • Related Data Elements (C.5) • All Diagnoses • Any Procedures • Sex • Age • Discharge/Disposition • Percentage of SIDRs Completed (D-Status)

Commander’sData Quality Statement • Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j) a) What percentage of inpatient records whose assigned DRG codes were correct?

Commander’sData Quality Statement • Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j) • b) Inpatient Professional Services Rounds encounters E & M codes audited and deemed correct?

Commander’sData Quality Statement • Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j) • c) Inpatient Professional Services Rounds encounters ICD-9 codes audited and deemed correct?

Commander’sData Quality Statement • Q. 5. Outcome of monthly inpatient coding audit: (C.5.c.f.g,h,i,j) • d) Inpatient Professional Services Rounds encounters CPT codes audited and deemed correct?

Data OutputMEPRS/EAS, ADM, CHCS, TPOCS • ADM • Timely Data Transmittal • Standard Ambulatory Data Record (SADR) • Error Logs • Workload Comparison

Data OutputOutpatient Coding • Sample Size • Accountability • Percentage Located or Properly Checked Out • Checked-out Over 30-Days? • DD Form 2569 (Third Party Insurance Information)

Commander’sData Quality Statement • Q.6. Outpatient Records. (c.6.a,b,c,d,e,f) • a) Is the documentation of the encounter selected to be audited available? Documentation includes documentation in medical record, loose (hard copy) documentation or an electronic record of the encounter in AHLTA?

Data OutputOutpatient Coding • E&M Codes • ICD-9 Codes • CPT Codes

Commander’sData Quality Statement • Q. 6. Outpatient Records. • b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.)

Commander’sData Quality Statement • Q. 6. Outpatient Records. • c) What is the percentage of ICD-9 codes deemed correct?

Commander’sData Quality Statement • Q. 6. Outpatient Records. • d) What was the percentage of CPT codes deemed correct? (CPT code must comply with current DoD guidance.)

Commander’sData Quality Statement • Question 7 Ambulatory Procedure Visits (C.7.a,b,c) • Questions 7.a,b,c, are the same as Questions 6.a,c,d,,

Commander’sData Quality Statement • Q. 8. Outcome of monthly inpatient audit: (C.8a,b,c,d,e,f) • a) What percentage of completed and current (signed within the past 12 months) DD Form 2569s are available for audit? • b) What percentage of available, current and complete DD Form 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?

Commander’sData Quality Statement • Q. 8. Outcome of monthly outpatient audit: (C.8a,b,c,d,e,f) • c) What percentage of completed & current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) are available for audit? • d) What percentage of available, current and completed DD Form 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?

Commander’sData Quality Statement • Q. 9. Comparison of reported workload data (C.9). • a) # SADR Encounters (count only visits / # WWR visits • b) # SIDR Dispositions / # WWR Dispositions • c) # EAS Visits / # WWR Visits • d) # EAS Dispositions / # WWR Dispositions • e) # IPSR SADR encounters (FCC=A***)/# Sum WWR (Total Bed Days + Total Dispositions + Live Births + Bassinet Days) Note: Question e, FY11 Goal is 80%.

Data OutputWorkload Comparison • Q.9a SADR Visits / WWR Visits • Should have an equal number of visits. • Encounters – Omit Appt. Status of “No-Shows,” “Canceled,” and Disposition Code “Left Without Being Seen”. • Encounters – Include Appt. Status “TelCon” • Only SADR Records Marked with an Appt. Status of “C” (complete) Are To Be Included. • Only “count” encounters are included.

Data OutputWorkload Comparison • Q.9b SIDR Dispositions / WWR Dispositions • Must Match • Only SIDRs With a Disposition of Status of “D” Are To Be Included • SIDRs – Exclude Carded for Record Only (CRO) and Absent Sick Records

Data OutputWorkload Comparison • Q. 9c EAS Visits / WWR Visits • Must Match • Include MEPRS Functional Cost Code B** (Outpatient) and FBN (Hearing Conservation) • Include APVs

Data OutputWorkload Comparison • Q. 9d EAS Dispositions / WWR Dispositions • Must Match • Only SIDRs with a Disposition Status of “D” are to be included

Data OutputWorkload Comparison • Q. 9e IPSR encounters (FCC=A***)/# Sum WWR (Total Bed Days + Total Dispositions + Live Births + Bassinet Days) • Must Match • Only SIDRs with a Disposition Status of “D” are to be included. • Insure WWR calculation includes live births (section 01) and Bassinet Days (section 00). Note: FY11 Goal is 80%

Commander’sData Quality Statement • Q.10. - System Design, Development, Operations and Education/Training (E.4.i). • # AHLTA SADR encounters/# of Total SADR encounters Note: FY11 compliance goal is 95%.. (* It is understood that not all clinical modules are deployed in the current version of AHLTA.)

Commander’sData Quality Statement • Q.11.- CHCS software used during the data month to identify duplicate patient registration records. (C.2a) - What was the number of potential duplicate records in the reporting month?

Commander’sData Quality Statement • Q.12.- Provide the number of incomplete and non-transmitted SIDRs for the month. (F.1) Note: This question on the DQ Statement is only a requirement for Army sites and will not be reported to TMA.

Commander’sData Quality Statement • Q.13.a.- Provide the number of loose forms/documents/papers that are currently waiting to be filed, either electronically or in the hard-copy medical record. (F.2.a) Note: This question on the DQ Statement is only a requirement for Army sites and will not be reported to TMA.

Commander’sData Quality Statement • Q.13.b.- Provide the number of loose forms/documents/papers that are currently waiting to be filed, either electronically or in the hard-copy medical record, 30 days after an active duty soldier has retired or separated from the service. (F.2.b) Note: This question on the DQ Statement is only a requirement for Army sites and will not be reported to TMA.

Commander’sData Quality Statement • Q. 14. – I am aware of data quality issues identified by the completed Commander’s Statement and Review List and when needed, have incorporated monitoring mechanisms and have taken corrective actions to improve the data from my facility.

Security • Are there internal controls and procedures in place to approve and manage assignment of security key privileges? • Have all security key holders been identified and their need for security key privileges validated by the CIO or designee?

System Design, Operations, and Education/Training • System Administrator Appointed In Writing for Each System • Training and Education Procedures and Documentation • System Change Request Process • System Incident Report • Routine Maintenance • Points of Contact for Equipment Failure Issues • Contingency Plans • Trouble tickets

Data Quality Management Control Program