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Data Quality Management Control Program (DQMC)

Data Quality Management Control Program (DQMC). AFMS Data Quality Program AFMSA/SGY. Overview. Data Quality (DQ) Program Systems DQ Composite Health Care System (CHCS) Initiatives FY10 Updates Take Away Questions. Data Quality Manager Data Quality Assurance Team DQMC Review List

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Data Quality Management Control Program (DQMC)

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  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. Data Quality Manager Data Quality Assurance Team DQMC Review List Data Quality Statement Department of Defense INSTRUCTION DQMC Program DODI 6040.40Military Health System Data Quality Management Control Procedures

  4. 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) DQ Team Roles and Responsibilities It is great to look – But are you working toward improvement?

  5. 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 DQ Team Roles and Responsibilities 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 TPOCS Billable Encounters WAM Count Visits & Raw Services EAS IV “Eligible” Encounters CPT Codes Units of Service

  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 O U T P U T “E” – Support “D” – Ancillary “A” – Inpatient “B” – Outpatient “C” – Dental + “F” – Special Programs + “G” – Readiness Total Cost EAS-SA Manpower CHCS / WAM (Count only) RVUs RWPs CHCS SADR ICD/E&M/CPT SIDR DRGs 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 ToolsCont… • 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, E&M 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. 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, NOAA…etc) • Enable the Leadership to make informed decisions

  14. 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/

  15. Provider Profiles (con’t) 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 #:

  16. 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

  17. Provider Specialty Codes • Enter Provider Specialty Code (Be specific – notgeneral) • All PA’s – 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

  18. 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 E&M 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 E&M Code 99214 – Level 4 Established Patient OHI – Yes CMAC Value = UNKNOWN Will you bill for this patient? NO Reimbursement $0 PPS Workload = ZERO!!!!!! Value of Care

  19. 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)

  20. AFMS –CHCS Provider File % of Total Error/Discrepancy By Error Type- Jul 2009

  21. 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

  22. Volume and error types will dictate cleanup strategies Peer Group Comparison

  23. Provider Report Card(continued – page 2) Monthly error rates for the MTF

  24. 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

  25. 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

  26. 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

  27. Way Ahead - Conceptual Report“Potential” 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 “What’s in it for them” 28 28

  28. DQ Tool Kit • Data Quality Statement Guide • Reporting Consistency • Training document for new personnel • AFMOA Resolution Guide – How to guide produced to assist MTF’s 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

  29. Sample of Continuity Guide Provider File Standards and Business Rules

  30. Sample of Workload Guidelines

  31. DQ Web Page Contact:Darrell 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?functionalArea=DataQuality Documents, briefings, policies/directives, training and links

  32. 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.

  33. 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

  34. 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)

  35. 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

  36. Question 3. Continued…New 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 Data Quality StatementValidation and Reconciliation

  37. 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

  38. 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

  39. 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 • E&M: Number of correct E&M codes Total number of E&M codes • CPT: Number of correct CPT codes Total number of CPT codes

  40. 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?

  41. 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

  42. 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.

  43. 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

  44. 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.

  45. 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

  46. 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 (FCC=A***)/#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)

  47. 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.

  48. 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”.

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