TMA DQ Course AF Break-Out Session

1. TMADQ Course AF Break-Out Session AFMOA/SGAR 4 MAR 10

2. TMA DQ Course AF Break-Out Session - Overview Organization MTF Engagement DQ Program Best Practices CHCS Provider File Improvement Efforts Other DQ Initiatives Specific Training Optional Training DQ POCs Important References Useful Website

3. Organization

4. MTF DQ Engagement • One-on-one support • Telephone • E-mail: afmoa.dq@lackland.af.mil • Defense Connect Online (DCO) • 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

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

6. 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.

7. MTF DQ Engagement (continued…) • AF portion of the TMA DQ Course • Other training/interaction forums: • Annual RMO, UBO/UBU Conferences, etc…. • Staff Assistance 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

8. MTF DQ Engagement (continued…) • 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 and 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\

11. TMA DQ Course AF Break-Out Session • Why is DQ Important? • Revenue Cycle • DQ System Architecture • How is Your Data Used • Success Factors • HSI Requirements • DQ Toolkit…a.k.a. Vector Check • DQ Assurance Team • DQ Review List • DQ Statement

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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) • 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

19. DQ MUG • Primary AF Specific DQ Guidance • DQ Statement clarification • 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:

20. 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

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

22. 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

23. 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

24. DQ Assurance Team Improvement Opportunities • Patient safety • CHCS Training • Accountability • Billing • Improve data accuracy • Include critical data elements • Correct critical data elements • Capture workload and revenue opportunities

25. Data Quality Review List • Refining/expanding beyond DQ statement • Internal tool to assist in identifying and correcting financial and clinical workload data problems • Monthly Requirement • All variances should be briefed with DQ Team and Executive Committee • DQMC Review List is required to have all supporting summary documentation kept on file for five years • eDQ will be based on the Review List

26. Data Quality Statement • DQ Statement • Reminders • Comments • BDQAS • MEWACS • Electronic DQ (eDQ) Review List and Statement

27. Data Quality StatementReminders • The due date is NLT the 25th of the month. If the 25th falls on a weekend, please have statement submitted the Friday prior • Submitted Spreadsheet to AFMOA should match exactly what the CC signed • DQMC Statement is required to have all supporting summary documentation kept on file for five years • The coding audit due dates will change effective April. The audit previous was due approximately the 20th of each month but now will be due approximately the 15th of each month • The auditors will still have over a month to complete the audit • MTFs need back up plans for Data Quality and all other areas that support answering the Statement.

28. DQ Statement Comments • Do not use ‘see item above’ • Must have problem, corrective action plan, and estimated completion date (include trouble tickets, if applicable) • Clear and concise • Required all areas in red • Please check spelling on comments, numerous typos on many • Don’t use “I” since the CC is signing the Statement, it would infer that the CC couldn’t get a task complete • Comments included on your MTF Statement are posted word for word on TMA and vector check websites • Upwards trend of comments not being related to question • I.e.. Inpatient comments given for outpatient question (vice versa)

29. DQ Statement Comments (continued…) • Question 1a, comments are required if yellow or red • Question 3c and 3d, comments are required if under 100% • Question 3d • Not only about submission, but also approval • If the percentage you have here is less than the submitted percentage, then you need to explain what is the problem with the approval process • Cannot be greater than 3c • This percentage is not calculated by the percentage of timecards approved that were submitted. This percentage is calculated out of the entire number of timecards that should have been submitted.

30. DQ StatementBDQAS • https://bdqas.brooks.af.mil/index2.htm • Biometric Data Quality Assurance Service (BDQAS) is a source for many DQ Statement questions • Updated on the 10th or 11th for non-EAS data • EAS data on BDQAS is updated between the 16 thru 20th

31. Select Data Metrics BDQAS • Share MUG with your entire DQ team

32. Select Data Quality Statement Reports

33. Select the command for your MTF

34. Select the command for your MTF

35. Select your MTF and then the data month These are the questions and percentages for each question BDQAS pulls Note: Manual procedures in DQ MUG if needed

36. DQ StatementMEWACS • Proactively identify, investigate, and resolve MEPRS data anomalies in a timely, systematic manner • Data Quality Statement question 3b. • Data that is identified as erroneous should be fixed and retransmitted • MEWACS is normally updated approximately on the 16th of each month • TMA centrally tracks site “hits” by base…compare outliers to hits • AFMOA MEPRS uses Vector Check to help identify outliers prior to them becoming outliers on MEWACS • Download the MEWACS Excel file for the Review Month from the MEWACS web site at http://www.meprs.info/mewacsxls.cfm

37. User guide is very helpful step by step tool. Also you can download an excel file of you MEWACS info. Click here

38. Data Load Status Summary Outliers WWR/EAS IV Allocation Test

39. Data Load Status

40. Summary Outliers

41. WWR/EAS IV

42. Allocation Test

43. Electronic DQ (eDQ) Review List and Statement • Automate DQ Review List and Statement production at the MTF • Eliminate repetitive consolidation at various higher HQ levels • Will enable all involved to spend more time correcting DQ, improving processes, enhance decision making • Development originally linked to Vector Check design/deployment • Stalled for a variety of reasons: differing corporate memory; funding/EOY; evolving requirement request processes • Way Ahead (No firm ECD, but it’s coming): • Prototype almost complete • Verbal commitment from AFMOA leadership to fund completion • Deploy at test sites/collect feedback…adjust…deploy AF-wide • Design/implement performance metrics

44. 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

45. 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

46. 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”

47. CHCS Provider File Errors • CHCS Provider File fields analyzed for errors • Naming Convention • NPI- Null • NPI – Duplicate • Signature Class/Provider Specialty Code (PSC) mismatch • Signature Class • PSC • HIPAA Taxonomy • Primary Hospital Location • DEA/License # • Generic Provider • Potential Duplicates

48. Error Criteria

49. Error Criteria (continued…)

50. 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