Data Quality Management Control Program

Data Quality Management Control Program Service-Level Breakout Session 13 September 2012 UNCLASSIFIED

Overview • Regulatory Guidance • Program Management • Organizational Factors • System Inputs, Processes, and Outputs • CHCS • ADM • MEPRS/EAS • TPOCS • MEWACS • Patient Records Accountability

Overview Coding Audits Sampling Size and Techniques Inpatient Records Outpatient Records Workload Comparison Regulatory Guidance System Security System Design, Development, Operations, and Education and Training

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.a)

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 calendar days of the encounter? (B.6.b) • c) What percentage of Inpatient records have been coded within 30 calendar 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,c,e,f) • a) Was the monthly MEPRS/EAS financial reconciliation completed, validated and approved by the MTF Resource Manager (i.e. Navy/Army Comptroller or Air Force Budget Officer/Analysts) prior to MEPRS monthly 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 and allocation tabs in the MEWACS document reviewed and explanations provided in the comments section 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 submitted timecards 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 Registration • 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,b,c,d). • 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 following month)

Commander’sData Quality Statement • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3). • c) CAPER (ADM) - daily Number of successful daily transmissions / Number of days in the month.

Commander’sData Quality Statement • Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3). • d) Daily OutpatientWorkload DetailReport (DOWDR) or Daily Patient Appointment Files – daily transmissions. Number of successful daily transmissions / Number of days in the month.

Data Output • A minimum of 30 records/encounters should be pulled randomly from the entire population of MTF for 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 considering the development of pull-list for auditing purposes, for inpatients and APVs. (The PASBA already creates a monthly pull-list for auditing of DD Form 2569s for inpatients, outpatients and APVs).

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 quarterly *(monthly) inpatient coding audit: (C.5.c.f.g,h,). • a) Percentage of inpatient medical records whose assigned DRG Codes were correct? • Formula: Number of correct MS-DRG codes / total number of MS-DRGs. * Army will continue to require monthly inpatient coding audits.

Commander’sData Quality Statement • Q. 5. Outcome of quarterly * (monthly) inpatient coding audit: (C.5.c.f.g,h) • b) Percentage of Inpatient Professional Services Rounds encounters E & M codes audited and deemed correct? • Formula: Number of correct E&M codes / total number of E&M Codes. * Army will continue to require monthly inpatient coding audits.

Commander’sData Quality Statement • Q. 5. Outcome of quarterly * (monthly) inpatient coding audit: (C.5.c.f.g,h,) • c) Percentage of Inpatient Professional Services Rounds encounters ICD-9 codes audited and deemed correct? • Formula: Number of correct ICD-9 codes / total number of ICD-9 codes. * Army will continue to require monthly inpatient coding audits.

Commander’sData Quality Statement • Q. 5. Outcome of quarterly * (monthly) inpatient coding audit: (C.5.c.f.g,h,) • d) Percentage of Inpatient Professional Services Rounds encounters CPT codes audited and deemed correct? • Formula: Number of correct CPT codes / total number of CPT codes. * Army will continue to require monthly inpatient coding audits.

Commander’sData Quality Statement • Q.6. Outcome of quarterly * (monthly) Outpatient Record audits. (c.6.a,b,c,d) • a) Is adequate 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? (Denominator equals sample size.) • Formula: Number of adequately documented encounters available / number of requested encounters. * Army will continue to require monthly outpatient coding audits.

Commander’sData Quality Statement • Q. 6. Outcome of quarterly * (monthly) Outpatient Record audits. • b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.) • c) What is the percentage of ICD-9 codes deemed correct? • d) What is the percentage of CPT codes deemed correct? (CPT code must comply with current DoD guidance.) • Formula: Number of correct ___ codes / total number of ___ codes. * Army will continue to require monthly outpatient coding audits.

Commander’sData Quality Statement • Question 7 Outcome of quarterly * (monthly) Ambulatory Procedure Visits (C.7.a,b,c) • c) What is the percentage of ICD-9 codes deemed correct? • d) What is the percentage of CPT codes deemed correct? (CPT code must comply with current DoD guidance.) • Formula: Number of correct ___ codes / total number of ___ codes. * Army will continue to require monthly APV coding audits.

Commander’sData Quality Statement • Question 8. DD-2569 forms. (C.8.a,b,c,d,e,f) • Inpatient dispositions: • a) What percentage of completed and current (signed • within the past 12 months) DD Form 2569s (TPC Insurance • Info) is available for review? • Formula: Number of complete and current DD 2569s / number of • non-active duty records audited. • b) What percentage of available, current and completed DD • Form 2569s is verified to be correct in the Patient Insurance • Information (PII) module in CHCS? • Formula: Number of correct entries in PII module / number of • available, current and complete DD Form 2569s.

Commander’sData Quality Statement • Question 8. DD-2569 forms. (C.8.a,b,c,d,e,f) • Outpatient encounters: • c) What percentage of completed and current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) is available for review? • Formula: Number of complete and current DD 2569s / number of • non-active duty records audited. • 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? • Formula: Number of correct entries in PII module / number of • available, current and complete DD Form 2569s.

Commander’sData Quality Statement • Question 8. DD-2569 forms. (C.8.a,b,c,d,e,f) • APVs: • e) What percentage of completed and current (signed within the past 12 months) DD Form 2569s (TPC Insurance Info) is available for review? • Formula: Number of complete and current DD 2569s / number of • non-active duty records audited. • f) What percentage of available, current and complete DD form 2569s is verified to be correct in the Patient Insurance Information (PII) Module in CHCS? • Formula: Number of correct entries in PII module / number of • available, current and complete DD Form 2569s.

Commander’sData Quality Statement • Q. 9. Comparison of reported workload data (C.9). • a) # of CAPER Encounters / number of kept appointments. • b) # of MEPRS Dispositions / # of SIDR “D” and “E” status. • c) # of MEPRS Visits / # of Kept Appointments (count only) • d) # of Inpatient Professional Services Rounds CAPER encounters (A*** CAPERs) / # of Total Bed Days + Dispositions (from EAS)

Data OutputWorkload Comparison • Q.9a CAPER Visits / Number of Kept Appointments (DOWDR) • 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” and “Occ-Svc” • Only CAPER records marked with an Appt. Status of “C” (complete) are to be included.

Data OutputWorkload Comparison • Q.9b MEPRS Dispositions / Number of SIDR “D” and “E” status dispositions • Should have an equal number. • MEPRS Dispositions will come from EAS. • Only SIDRs With a Disposition of Status of “D” (Completed) and “E” (Disposition) are to be included • SIDRs – Exclude Carded for Record Only (CRO) and Absent Sick Records.

Data OutputWorkload Comparison • Q. 9c MEPRS Visits / Number of Kept Appointments (count). • Should have an equal number. • Include MEPRS Functional Cost Code B** (Outpatient) and FBN (Hearing Conservation) • Include APVs. • Kept appointments are count only and come from DOWDR.

Data OutputWorkload Comparison • Q. 9d Inpatient Professional Services Rounds CAPER encounters (A*** CAPERs) / # Total Bed Days + Dispositions from EAS. • Should have an equal number. • IPSRs can be identified in CAPER files with a Functional Cost Code of A***. Note: FY13 Goal is 95%.

Commander’sData Quality Statement • Q.10. Use CHCS during the data month to identify potential duplicate patient registration (C.2a) • For CHCS/AHLTA hosts only, what was the number of potential duplicate patient registration in the data month for all MTFs under the host? List the DMIS IDs of the MTFs included in the comments section.

Commander’sData Quality Statement • Q.11. 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.12.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. 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.12.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. 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. I am aware of data quality issues identified by the completed Data Quality Statement and the Data Quality 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 • Incident tickets

Data Quality Measures Timely completion of outpatient workload • Approximately 60-65% completed on same day as encounter • Use ADM Compliance report to track completion of workload • Timely completion is not dependent on coder staffing • Develop AIMS forms to assist provider with frequently used codes • Monitor clinics and/or providers which are least compliant

Data Quality Measures Admin Closed appointments • When to use: • Training and testing purposes • Duplicate encounters • Appointment created in error • No actual interaction with patient • When not to use: • Incomplete documentation • No-Show or cancelled appointment • Passage of time

Data Quality Measures Collection of Other Health Insurance • Consistent and on-going training of staff • SOPs • Uniform Business Office to conduct training • Educate patients • Posters within clinics and MTF • News articles • Pamphlets addressing most common questions • Identification of patients • Insurance cards issued by MTF • Electronic DD Form 2569 • OHI Discovery contracts

Provider Aggregate (PA) RVU • Both PPS and PBAM will use Provider Aggregate (PA) RVU for FY12 • Nurses and Techs (Skill Types 3 and 4) will receive credit only for specific CPT/HCPCS codes • Multiple Provider Discounting • Multiple Procedure Discounting • Modifier Impact • Procedure Clean-up • No credit for J, K, L HCPCS codes • Targets adjusted for both PPS and PBAM to account for differences • Enhanced RVU still appropriate for cost comparisons to purchased care

Outpatients, within 3 Business Days Slide 50 of 95

Data Quality Management Control Program