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Data Quality Management Control Program (DQMC)

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Data Quality Management Control Program (DQMC) AFMS Data Quality Program AFMSA/SGY * AFMS CHCS Provider File % of Total Error/Discrepancy By Error Type- Jul 2009 ... – PowerPoint PPT presentation

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Title: Data Quality Management Control Program (DQMC)


1
Data Quality Management Control Program (DQMC)
AFMS Data Quality Program AFMSA/SGY
2
Overview
  • Data Quality (DQ) Program
  • Systems
  • DQ Composite Health Care System (CHCS)
    Initiatives
  • FY10 Updates
  • Take Away
  • Questions

3
DQMC Program
  • Data Quality Manager
  • Data Quality Assurance Team
  • DQMC Review List
  • Data Quality Statement

DODI 6040.40Military Health System Data Quality
Management Control Procedures
4
DQ Team Roles and Responsibilities
  • Team Key Players
  • DQ Manager
  • Resource Management Office (RMO)
  • Group Practice Manager (GPM)
  • Medical Expense and Performance Reporting System
    (MEPRS)
  • Credentials Manager
  • Budget Analyst/Uniform Business Office (UBO)
  • Coding/Billing Supervisor
  • Clinical Systems Administrator(s)
  • It is great to look But are you working toward
    improvement?

5
DQ Team Roles and Responsibilities
  • DQ team meets monthly
  • Review Metrics/Compliance Issues
  • Provide deficiency correction plan and estimated
    completion date (if applicable)
  • Report monthly to Executive Committee
  • Keep meeting minutes for at least two years
  • Keep Review Lists for five years
  • It is great to look But are you working toward
    improvement?

6
DQ Team Responsibilities Cont
  • DQMC Review List
  • Maintained locally
  • Tool to assist Military Treatment Facilities
    (MTFs) in identifying and correcting financial
    and clinical workload data problems monthly
  • Data Quality Statement
  • Facility Report Card
  • Specific information from the DQMC Review List
  • Commander signs/approves monthly
  • Forwarded through the regional office to AF DQ
    Manager
  • AF summary submitted to DQMC

7
DQ System Architecture
Clinical Data Mart
Air Force
TRICARE Ops Center
Worldwide Workload Report
Service Repository (BDQAS)
WWR (Count Visits)
DoD/VA SHARE
MHS Data Repository
MDR
Coding Compliance Editor
SADR (Encounters)
CCE
Standard Ambulatory Data Record
Pop Health Portal
SADR 1/SADR 2
PDTS
ADM Extract
Pharmacy Data Transaction System
MHS Mart
M2
EAS Repository
EAS IV Eligible Encounters CPT Codes Units of
Service
WAM Count Visits Raw Services
TPOCS Billable Encounters
8
Medical Expense and Performance Reporting
System MEPRS -- Valuation

EAS IV
CRIS
R E C O N C I L E
Direct Care Step Down
Money
E Support D Ancillary
A Inpatient B
Outpatient C Dental
F Special
Programs
G Readiness
O U T P U T
Total Cost
EAS-SA
Manpower
CHCS / WAM (Count only)
RVUs RWPs
CHCS
SADR
ICD/EM/CPT
DRGs
SIDR
Workload
Defense Health Program Cost Accounting
9
DQ Monitoring Tools
  • MHS Management Analysis and Reporting Tool (M2)
  • Used to extract data for PPS and AF Business Plan
  • Need to identify the M2 user and alternate in
    your facility
  • TMA WISDOM course
  • EASIV Repository
  • MEPRS data
  • Cost per data
  • 45 day processing period for current month
  • MEPRS Manager
  • TMA MADI Course

10
DQ Monitoring Tools Cont
  • MEPRS Early Warning and Control System (MEWACS)
  • Trend analysis tool
  • Usage monitored by DQMC
  • Outlier indications
  • Review and correct data accordingly
  • Outliers are not always incorrect data

11
DQ Monitoring Tools Cont
  • BDQAS
  • Ambulatory and Inpatient Metrics
  • FY Point-in-time" Comparison Reports
  • Updated on the 20th of the month
  • Display by MTF or MAJCOM
  • MTF Rankings, Transmission Reports
    (daily/summary), Top DRG, "Principal" Diagnosis
    and Procedure Reports, EM by Provider Specialty
  • Data Quality Statement Reports
  • Compare and report values on DQ statement
  • Consistent reporting for questions 1a, 2a-b,
    4b-d, 8a-d, 9

12
BDQAS
13
(No Transcript)
14
How is your data used?
  • BRAC
  • Monitor efficiency of the healthcare system
  • Performance Based Budgeting PPS
  • Medicare Accrual Fund
  • MTF Business Plans
  • Provider/Clinic Workload Productivity
  • Determine Level of Effort by all clinic staff
  • Reimbursements (TPC, Coast Guard, NOAAetc)
  • Enable the Leadership to make informed decisions

15
Provider File
  • Civilian (Outside) Provider File
  • Pharmacy/Lab/Rad are required to add the Civilian
    Provider to CHCS. Is there a local policy?
  • Create a local policy/standard operating
    procedure
  • Educate and train the ancillary staff
  • Use correct PSC linked to HIPAA Taxonomy
  • Provider naming convention, NPI, and DEA/License
    number should be strictly enforced and monitored
  • Last Name/First Name, Middle Name or Initial (if
    available)
  • Example Smith / Johnson,S / Provider / Outside
    Provider
  • Recommend subscribing to HCIdea to research
    NPI/DEA/License http//www.hcidea.org/

16
Provider Profiles (cont)
Corrected fields in red PROVIDER SMITH,JOHN R
Name
SMITH,JOHN R Provider Flag PROVIDER Provider
ID SMITHJR NPI Type/ID 01/0125899 Provider
Class OUTSIDE PROVIDER Person Identifier
Person ID Type Code Select PROVIDER
SPECIALTY 001 (FAMILY PRACTICE
PHYSICIAN) Primary Provider Taxonomy
207Q00000X CMAC Provider Class - Select
PROVIDER TAXONOMY HCP SIDR-ID Location
CHAMPUS SUPPORT Class OUTSIDE PROVIDER
Initials JRS SSN 123-45-6789 (Not
Mandatory) DEA BM1212127 License
Incorrect fields in red PROVIDER SMITH, JOHN R
Name SMITH,
JOHN R Provider Flag PROVIDER Provider ID
Provider1234 NPI Type/ID Provider Class
Doc Person Identifier 123-45-6789 Person ID
Type Code Select PROVIDER SPECIALTY 517
(DENTAL CONSULTANT) Primary Provider
Taxonomy CMAC Provider Class - Select
PROVIDER TAXONOMY HCP SIDR-ID Location
CHAMPUS SUPPORT Class OUTSIDE PROVIDER
Initials JRS SSN 123-45-6789 DEA
99999999 License
17
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

18
Provider Specialty Codes
  • Enter Provider Specialty Code (Be specific not
    general)
  • All PAs Provider Specialty Code 901
  • All Technicians Provider Specialty Code 900
  • Independent Duty Medical Technician Provider
    Specialty Code 521
  • Lost revenue for codes 500 518 and 910 999
  • Zero workload RVU
  • Prevent Encounter from flowing to TPOCS
  • Impact on PPS
  • Provider Specialties 910 and above are Clinical
    Services

19
Value of Care
  • PEDIATRICS BDA
  • Provider Specialty Code 040
  • Pediatrician
  • Diagnosis Codes
  • 204 Lymphoid Leukemia
  • 112.89 Candidial Endocarditis
  • Procedure Code
  • 90780 Intravenous infusion for therapy/diagnosis,
    administered by physician or under direct
    supervision of physician up to one hour
  • 90781 Each additional hour
  • EM Code
  • 99214 Level 4 Established Patient
  • OHI Yes
  • CMAC Value 130.73 Class 1 Provider
  • Will you bill for this patient? Yes
  • Reimbursement - 130.73
  • PPS RVU 1.44 Reimbursement 106.56
  • PEDIATRICS BDA
  • Provider Specialty Code 949
  • Pediatrics
  • Diagnosis Codes
  • 204 Lymphoid Leukemia
  • 112.89 Candidial Endocarditis
  • Procedure Code
  • 90780 Intravenous infusion for therapy/diagnosis,
    administered by physician or under direct
    supervision of physician up to one hour
  • 90781 Each additional hour
  • EM Code
  • 99214 Level 4 Established Patient
  • OHI Yes
  • CMAC Value UNKNOWN
  • Will you bill for this patient? NO
  • Reimbursement 0
  • PPS Workload ZERO!!!!!!

20
AF CHCS DQ Initiative
  • Contract awarded Sept 06
  • Hired 2 contractors
  • Review and analyze CHCS File and Table Build
  • Provider File
  • Provide functional and technical guidance
  • Provider File Report Card (SAR replacement)
  • Establish CHCS DQ standards
  • Process ownership of data elements
  • Policies, business rules, and AFMS
    standardization (CHCS DQ Continuity Guide, AFMOA
    Resolution Guide)

21
AFMS CHCS Provider File of Total
Error/Discrepancy By Error Type- Jul 2009
Error-Discrepancy TOTAL
NPI - NULL 276960 46
NPI - Duplicate 3027 0
Generic Provider 1543 0
Potential Duplicate 3328 1
Naming Convention 20749 3
DEA / License 3705 1
SSN 0 0
Specialty Code (PSC) 14647 2
HIPAA Taxonomy 41143 7
Pclass MisMatch 2013 0
Primary Hospital Location 5364 1
Signature Class 3652 1
EDI-PN 0 0
TOTAL 376131 62
TOTAL RECORDS REVIEWED 605809
22
New and Improved ProcessProvider File Detail
Data Base
  • Data Quality Contract Personnel developed the
    following approach
  • Smartronix sub to PSI
  • Central DSS Provider File pull from each MTF CHCS
  • Automated query identified potential
    errors/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 efforts on recent activity
  • Generates a MTF Provider File Report Card
  • Sample on next slide

23
Volume and error types will dictate cleanup
strategies
Peer Group Comparison
24
Provider Report Card(continued page 2)
Monthly error rates for the MTF
25
New and Improved ProcessMTF Provider File Report
Cards
  • MTF Report Cards
  • Automatically generated from the MTF detail file
  • Baseline MTF CHCS provider file metrics
  • Shows types of errors/discrepancies
  • Shows the primary effect/impact
  • Focused two-page format
  • More readable and actionable
  • Includes performance measures (peer-group based)
  • Error rates for each MTF/DMIS captured
  • Monthly trend analysis of new provider entries
  • Other statistical information captured for future
    comparison
  • AFMOA DQ Follow-up ingrained in the process

26
CHCS Provider FileRoles and Responsibilities
Provide analysis for the MTF
Guide MTF through data clean-up
AFMOA SGAR/Data Quality Program Office
Provide performance measures
Action plan for clean-up
Conduct site visits as needed
Help MTFs focus efforts
MTF DQ Team
Indentify training issues
Share data with proper DQ teammates
Facilitate training
Provide MTFs recommended processes/ share best
practices
Provide feedback to AFMOA/DQ
Report data at DQMC
27
Way Ahead
Way Ahead

Baseline (10Aug-Rpt Card) FY10- 2nd Qtr (15
Oct-Rpt Card) FY 10 2nd Qtr (15 Jan- Rpt
Card) FY 10 3rd Qtr (15 Apr- Rpt Card)
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
Baseline -All active providers
Order Entry activity to focus on recent
activity (conceptual report on next slide)
Match w/OHI information
Annual review
27
28
Way Ahead - Conceptual ReportPotential Impact
to TPC
  • Conceptual report that will show MTFs potential
    lost
  • Reflects providers with NULL provider NPIs, not
    the rest of the errors
  • Reflects current primary insurance listed in CHCS
  • Opportunity to show the MTFs Whats in it for
    them

28
28
29
DQ Tool Kit
  • Data Quality Statement Guide
  • Reporting Consistency
  • Training document for new personnel
  • AFMOA Resolution Guide How to guide produced to
    assist MTFs in the provider data cleanup process
  • CHCS DQ Continuity Guide, Version 2
  • CHCS Standardized Business Rules
  • AFMS Workload Guidelines
  • Version 2.0 (draft)
  • Brings together DQ, MEPRS, Coding and Billing
  • AF supplemental guidance to DOD coding guidelines

30
Sample of Continuity Guide
Provider File Standards and Business Rules
Data Element Description AF DQ Standards
National Provider Identifier (NPI) 10-Digit number for electronic billing For any provider flagged as Provider these files require an NPI number. If services are rendered by a provider containing no NPI, it will prevent claims to be paid for patients with Third Party Insurance
31
Sample of Workload Guidelines
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
32
DQ Web Page
ContactDarrell Dorrian, Interim Air Force Data
Quality Program Manager Tel (703) 681-6504 DSN
761 Fax (703) 681-6011 DSN 761
https//kx.afms.mil/kxweb/dotmil/kj.do?functionalA
reaDataQuality
Documents, briefings, policies/directives,
training and links
33
(No Transcript)
34
Data Quality StatementCompleteness
  • Question 1. In the reporting month (include only
    B and FBN accounts)
  • a) What percentage of clinics have complied with
    End of Day processing requirements, Every
    clinic Every day? (B.5.(a))
  • Question 1a is deleted for FY10.

35
Data Quality StatementCompleteness
  • Question 1. In the reporting month (include only
    B and FBN accounts) 1b becomes 1a
  • a) What percentage of appointments were closed in
    meeting your End of Day processing
    requirements, Every appointment Every day?
    (B.5.(b)) Source is BDQAS
  • Number of closed appointments
  • Total appointments for the month

36
Data Quality StatementTimeliness
  • Question 2. In accordance with legal and medical
    coding practices, have all of the following
    occurred
  • a) What percentage of Outpatient Encounters,
    other than APVs, has been coded within 3 business
    days of the encounter? Source is BDQAS
  • b) What percentage of APVs have been coded within
    15 days of the encounter? Source is BDQAS
  • c) What percentage of Inpatient records have been
    coded within 30 days after discharge? Internal
    Process - CCE Report (Un-coded records report)

37
Data Quality StatementValidation and
Reconciliation
  • Question 3. Medical Expense and Performance
    Reporting System for Fixed Military Medical and
    Dental Treatment Facilities Manual (MEPRS
    Manual), DoD 6010.13-M, dated April 7, 2008,
    paragraph C3.3.4, requires report reconciliation.
  • a) Was monthly MEPRS/EAS financial reconciliation
    process completed, validated and approved prior
    to monthly MEPRS transmission? Source is MEPRS
    Manager and RMO Office
  • b) 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? Source is
    MEPRS Manager

38
Data Quality StatementValidation and
Reconciliation
  • Question 3. ContinuedNew Questions on Timecards
    submitted by Service determined date.
  • c) For DMHRSi, what is the percentage of
    submitted timecards by the suspense date? Source
    is MEPRS Manager
  • Number of Timecards Submitted On-time
  • Total Number of Timecards for an MTF
  • d) For DMHRSi, what is the percentage of
    approved timecards by the suspense date? Source
    is MEPRS Manager
  • Number of Timecards Approved On-time
  • Total Number of Timecards for an MTF

39
Data Quality Statement Compliance
  • Question 4. Compliance with TMA or Service-Level
    guidance for timely submission of data (C.3.).
  • a) MEPRS/EAS (45 days) Source is MEPRS
    Manager/MEWACS
  • b) SIDR/CHCS (5th Duty of Day of the month)
    Source is BDQAS
  • c) WWR/CHCS (10th Calendar Day Following Month)
    Source is BDQAS
  • d) SADR/ADM (Daily) Source is BDQAS

40
Data Quality Statement Rounds Compliance
  • One calendar day of the attending professional
    services during each audited hospitalization will
    be audited from the randomly selected sample.
  • For one day hospitalizations, that calendar day
    will be audited.
  • For all other hospitalizations, the registration
    number will determine which calendar day will be
    audited.
  • Odd numbers will use the first day
  • Even numbers will use the second day

41
Data Quality Statement Coding Accuracy
Calculation
  • Use the following formulas for Q5b-d (Internal
    Process), 6b-d (Audit Tool), 7b-c (Audit Tool)
  • ICD-9 Number of correct ICD-9 codes
  • Total number of ICD-9 codes
  • EM Number of correct EM codes
  • Total number of EM codes
  • CPT Number of correct CPT codes
  • Total number of CPT codes

42
Data Quality Statement Compliance
  • Question 5. Outcome of monthly inpatient coding
    audit
  • a) Percentage of inpatient records whose assigned
    DRG codes were correct?
  • b) Inpatient Professional Services Rounds
    encounters E M codes audited and deemed
    correct?
  • c) Inpatient Professional Services Rounds
    encounters ICD-9 codes audited and deemed
    correct?
  • d) Inpatient Professional Services Rounds
    encounters CPT codes audited and deemed correct?

43
Data Quality Statement Availability/Accuracy
  • Question 5. Inpatient Records. CONT
  • e) What percentage of completed and current
    (signed within the past 12 months) DD Forms 2569
    (TPC Insurance Info) are available for audit?
    (How the patient answered is only relevant to
    answering Question 6f)
  • The DD Forms 2569 need to be available and
    current at the time of the audit to be in
    compliance with the UBO program.
  • Options for filing DD Form 2569
  • Maintain hardcopy DD Form 2569 in medical record
  • Scan DD Form 2569 and store electronically
  • Hardcopy DD Form 2569 stored in the MTF
    RMO/Business/TPC Office

44
Data Quality Statement Availability/Accuracy
  • Question 5. Inpatient Records. CONT
  • f) What percentage of available, current and
    complete DD Forms 2569s are verified to be
    correct in the Patient Insurance Information
    (PII) module in CHCS?
  • Internal Process based on Question 6e. Does not
    apply to OCONUS bases.

45
Data Quality Statement Availability/Accuracy
  • Question 6. Outpatient Records
  • a) Is the documentation of the encounter selected
    to be audited available? Documentation includes
    documentation in the medical record, loose (hard
    copy) documentation or an electronic record of
    the encounter in AHLTA. (Denominator equals
    sample size.)
  • 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.)
  • Source for a, b, c, d is Audit Tool

46
Data Quality Statement Availability/Accuracy
  • Question 6. Outpatient Records. CONT
  • e) What percentage of completed and current
    (signed within the past 12 months) DD Forms 2569s
    (TPC Insurance Info) are available for audit?
  • Audit Tool Generated/Internal Process (This
    metric only measures whether or not a DD Form
    2569 was collected/current in the record at the
    time of the encounter).
  • The DD Forms 2569 need to be available and
    current at the time of the audit to be in
    compliance with the UBO program.
  • f) What percentage of available, current and
    complete DD Forms 2569s are verified to be
    correct in the Patient Insurance Information
    (PII) module in CHCS?
  • Internal Process based on Question 6e. Does not
    apply to OCONUS bases.

47
Data Quality Statement Availability/Accuracy
  • Question 7. Ambulatory Procedure Visits
    (C.7.a,b,c,d,e)
  • Questions 7.a,b,c,d,e Are the same as Questions
    6.a,c,d,e,f

48
Data Quality Statement Completeness
  • Question 8. Comparison of reported workload data.
  • a) SADR Encounters (count only) / WWR
    visits Source is BDQAS
  • b) SIDR Dispositions / WWR Dispositions
    Source is BDQAS
  • c) EAS Visits / WWR Visits Source is BDQAS
  • d) EAS Dispositions / WWR Dispositions
    Source is BDQAS
  • e) of Inpatient Professional Services Rounds
    SADR encounters (FCCA)/Sum WWR (Total Bed
    Days Total Dispositions) Note FY10 Goal is
    80 (Will be graded red and green only)
  • Source is Monthly Statistical Report (Internal
    Process)

49
Data Quality Statement AHLTA Penetration
  • Question 9. System Design, Development,
    Operations, and Education/Training (E.4.a).
  • a. of AHLTA SADR encounters / of Total SADR
    encounters (ALL SADR encounters including APV
    and ER)
  • Source is BDQAS
  • Note This question is to gauge the penetration
    of AHLTA at our MTFs. It is understood that not
    all clinical modules are deployed in the current
    version of AHLTA.

50
Data Quality Statement AHLTA Penetration
  • Question 10. CHCS software used during the
    reporting month to identify duplicate patient
    registration records. (C.2a)
  • a)  What was the number of potential duplicate
    records in the reporting month? (NOTE Only
    Host sites report up.) Source is Internal
    Process
  • Run the CHCS standard report Potential
    Duplicate Patient Search.

51
Data Quality Statement Awareness
  • Question 11. I am aware of data quality issues
    identified by the completed DQ Statement and DQMC
    Review List and when needed, have incorporated
    monitoring mechanisms and have taken corrective
    actions to improve the data from my facility.
    (Electronic Signature Authorized)

52
Take Away
  • DQ is not just the DQ statement.
  • Data needs to be accurate, complete and timely.
  • Front-end processes are CRITICAL to back-end
    success

53
Important References
  • DODI 6015.1-M, DOD Glossary
  • DODI 6010.13M, MEPRS Program for Fixed MTFs and
    DTFs
  • DODI 6010.15M, Uniform Business Office
  • DODI 6040.40, Data Quality Program
  • DODI 6040.41, Medical Records Retention and
    Coding at MTF
  • DODI, 6040.42, Medical Encounter and Coding at
    MTF
  • DODI, 6040.43, Custody and Control of Medical
    Records
  • AFI 41-102, AF MEPRS Program for Fixed MTFs and
    DTFs
  • AFI 41-120, Resource Management Operations
  • AFI 41-210, Patient Administration Functions
  • DoD Professional Coding Guidelines
  • AF Workload Standardization Guidelines
  • EASIV Reference Guide

54
Useful Web Sites
  • Data Quality
  • http//www.tricare.mil/ocfo/mcfs/dqmcp/management_
    control.cfm
  • BDQAS - https//bdqas.brooks.af.mil/index2.htm
  • UBU - http//www.tricare.mil//ocfo/bea/ubu/index.c
    fm
  • UBO - http//www.tricare.mil/ocfo/mcfs/ubo/about.c
    fm
  • MEPRS http//meprs.info
  • DMHRSi - https//dmhrsi.satx.disa.mil
  • https//kx.afms.mil/kxweb/dotmil/kj.do?functionalA
    reaDMHRS1
  • MEWACS - http//www.meprs.info/mol3/mol3.cfm
  • DFAS -  https//mypay.dfas.mil/mypay.aspx
  • HIPAA -  http//tricare.osd.mil/ocfo/mcfs/ubo/hipa
    a.cfm
  • SAIC -  http//www.chcs-dm.com/

55
QUESTIONS?
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