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Data Quality Management Control Program

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Data Quality Management Control Program Army Mr. Tim Bacon Overview Regulatory Guidance Program Management Organizational Factors System Inputs, Processes, and ... – PowerPoint PPT presentation

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Title: Data Quality Management Control Program


1
Data Quality Management Control Program
  • Army Mr. Tim Bacon

2
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

3
Regulatory GuidanceDODI 6040.40Military Health
System Data Quality Management Control Procedures
Department of Defense
INSTRUCTION
4
Regulatory GuidanceDODD 6040.41Medical Records
Retention and Coding at Military Treatment
Facilities
Department of Defense
DIRECTIVE
5
Regulatory GuidanceDODD 6040.42 Medical
Encounter and Coding at Military Treatment
Facilities
Department of Defense
DIRECTIVE
6
Regulatory GuidanceDODD 6040.43Custody and
Control of Outpatient Medical Records
Department of Defense
DIRECTIVE
7
Regulatory GuidanceDODD 6040.43Custody and
Control of Outpatient Medical Records
Department of Defense
DIRECTIVE
8
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

9
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)
  • Third Party Outpatient Collection System (TPOCS)
  • MEPRS Early Warning and Control System (MEWACS)

10
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

11
CommandersData Quality Statement
  • Q. 1. In the reporting month
  • a) What percentage of clinics have complied with
    End of Day processing requirements, Every
    clinic Every day? (B.5.(a.))
  • b) What percentage of appointments were closed in
    meeting your End of Day processing
    requirements, Every appointment Every day?
    (B.5.(b))

12
CommandersData 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))

13
CommandersData Quality Statement
  • Q. 2. In accordance with legal and medical coding
    practices, have all of the following occurred
  • c) What percentage of Inpatient records have been
    coded within 30 days after discharge? (B.6.(c))

14
Data OutputMEPRS/EAS, ADM, CHCS, TPOCS
  • EAS
  • Financial Reconciliation
  • Inpatient and Outpatient Workload Reconciliations
  • MEWACS Review
  • Timely Data Transmittal
  • Workload Comparison

15
CommandersData Quality Statement
  • Q. 3. In accordance with TMA policy,
    Implementation of EAS/MEPRS Data Validation and
    Reconciliation, dated 21 Dec 99 and MEPRS Early
    Warning and Control System, dated 28 May 02,
    along with the most current Service-Level
    Guidance (C.1.)
  • a) Was monthly MEPRS/EAS financial reconciliation
    process completed?

16
CommandersData Quality Statement
  • Q. 3. In accordance with TMA policy,
    Implementation of EAS/MEPRS Data Validation and
    Reconciliation, dated 21 Dec 99 and MEPRS Early
    Warning and Control System, dated 28 May 02,
    along with the most current Service-Level
    Guidance (C.1.)
  • b) Were monthly Inpatient and Outpatient workload
    reconciliation processes completed?

17
CommandersData Quality Statement
  • Q. 3. In accordance with TMA policy,
    Implementation of EAS/MEPRS Data Validation and
    Reconciliation, dated 21 Dec 99 and MEPRS Early
    Warning and Control System, dated 28 May 02,
    along with the most current Service-Level
    Guidance (C.1.)
  • c) 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?

18
CommandersData Quality Statement
  • Q. 4. Compliance with TMA or Service-Level
    guidance for timely submission of data (C.3.).
  • a) MEPRS/EAS (45 days)
  • PASBA populates this response.

19
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

20
CommandersData Quality Statement
  • Q. 4. Compliance with TMA or Service-Level
    guidance for timely submission of data (C.3.).
  • b) SIDR/CHCS (No later than
  • 5th and 20th calendar day of the month)
  • PASBA populates this response.

21
CommandersData 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)
  • PASBA populates this response.

22
Commanders Data Quality Statement
  • Q.4. Compliance with TMA or Service-Level
    guidance for timely submission of data (C.3).
  • d) SADR/ADM (daily)
  • PASBA populates this response.

23
CommandersData Quality Statement
  • Q. 5.a. Outcome of monthly inpatient coding
    audit (C.5.(c,f))
  • Inpatient Records (DRG) Records
    Reviewed_________ Correct _______

24
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)

25
CommandersData Quality Statement
  • Q. 5.b. Outcome of monthly inpatient coding
    audit (C.5.(c,f))
  • IBWA Rounds encounters audited and deemed
    correct?

26
Data OutputMEPRS/EAS, ADM, CHCS, TPOCS
  • ADM
  • Timely Data Transmittal
  • Standard Ambulatory Data Record (SADR)
  • Error Logs
  • Workload Comparison

27
CommandersData Quality Statement
  • Q.6. Outpatient Records
  • a) Percentage of outpatient medical records
    on-hand containing the documentation and/or the
    loose documentation of the encounter selected to
    be audited or documented as checked out? (C.6)

28
Data OutputOutpatient Coding
  • Sample Size
  • Accountability
  • Percentage Located or Properly Checked Out
  • Checked-out Over 30-Days?
  • DD Form 2569 (Third Party Insurance Information)

29
CommandersData Quality Statement
  • Q. 6. Outpatient Records.
  • b) What was the percentage of E M codes deemed
    correct? (E M code must comply with current DoD
    guidance.) (C.6.(b))

30
CommandersData Quality Statement
  • Q. 6. Outpatient Records.
  • c) What was the percentage of ICD-9 codes deemed
    correct? (C.6.(c))

31
CommandersData Quality Statement
  • Q. 6. Outpatient Records.
  • d) What was the percentage of CPT codes deemed
    correct? (CPT code must comply with current DoD
    guidance.) (C.6.(d))

32
CommandersData Quality Statement
  • Q. 6. Outpatient Records.
  • e) What percentage of completed current DD Form
    2569s are maintained in the record (non-active
    duty)? (C.6.(e))

33
CommandersData Quality Statement
  • Q. 6. Outpatient Records.
  • f) What percentage of completed current DD Form
    2569s in the medical record were verified to be
    correct in the Patient Insurance file in CHCS?
    (C.6.(f))

34
CommandersData Quality Statement
  • Question 7 Ambulatory Procedure Visits
    (C.7.a,b,c,d,e,f)
  • Questions 7.a,b,c,d,e,f Are the same as Questions
    6.a,b,c,d,e,f

35
CommandersData Quality Statement
  • Q. 8. Comparison of reported workload data
    (C.9).
  • a) SADR Encounters / WWR visits
  • b) SIDR Dispositions / WWR Dispositions
  • c) EAS Visits / WWR Visits
  • d) EAS Dispositions / WWR Dispositions
  • e) of IBWA SADR encounters (FCCA)/Sum
    WWR (Total Bed Days
    Total Dispositions)
  • PASBA populates the numbers for these questions.

36
Data OutputWorkload Comparison
  • Question 8a
  • SADR Encounters / WWR Visits
  • Should Have More Encounters Than Visits
  • Encounters Omit Appt. Status of No-Shows,
    Canceled, and Disposition Code Left Without
    Being Seen
  • Encounters Include Appt. Status TelCon
  • Only SADR Records in B and FBN clinics that
    are marked with an Appt. Status of C (complete)
    Are To Be Included

37
Data OutputWorkload Comparison
  • Question 8b
  • 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

38
Data OutputWorkload Comparison
  • Question 8c
  • EAS Visits / WWR Visits
  • Must Match
  • Include MEPRS Functional Cost Code B
    (Outpatient) and FBN (Hearing Conservation)
  • Include APVs

39
Data OutputWorkload Comparison
  • Question 8d
  • EAS Dispositions / WWR Dispositions
  • Must Match
  • Only SIDRs with a Disposition Status of D are
    to be included

40
of IBWA SADR (RNDS appt type only encounters
(FCCA)/ SUM WWR Bed days
  • Question 8e
  • Industry Based Workload Alignment
  • The capture of the inpatient professional
    services is referred to as IBWA.

41
CommandersData Quality Statement
  • Q. 9. I am aware of data quality issues
    identified by the DQMC Review List and when
    needed, have taken action to improve the data
    from my facility.

42
Security
  • Responsibilities Formally Assigned?
  • HIPAA Compliance
  • Password Protection
  • Access
  • Confidentiality
  • Level of Access

43
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

44
Data Quality Section, PASBA

Mr. Joseph (Tim) Bacon
Chief DQ Section / Army DQ Mgr
Telephone (210) 295-8725
Joseph.Bacon_at_amedd.army.mil Ms.
Deborah Lundberg Mr. Angel
Padilla NARMC DQ Representative
WRMC/ PRMC / 18th MEDCOM (210) 295-8923 DSN 421
DQ Representative

(210) 295-8842 Mr. Joe Alley
Ms. Vicki Vestal SERMC/ ERMC
GPRMC DQ
Representative DQ Representative
(210) 295-8931 (210) 221-0467 DSN
421
http//www.pasba.amedd.army.mil
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