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

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Data Quality Data Quality Management Control Management Control

ProgramProgram

Army – Mr. Tim BaconArmy – Mr. Tim Bacon

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OverviewOverview

• Regulatory GuidanceRegulatory Guidance• Program ManagementProgram Management• Organizational FactorsOrganizational Factors• System Inputs, System Inputs,

Processes, and OutputsProcesses, and Outputs– CHCSCHCS– ADMADM– MEPRS/EASMEPRS/EAS– TPOCSTPOCS– MEWACSMEWACS

• Patient Records Patient Records AccountabilityAccountability

• Coding AuditsCoding AuditsSampling Size and Sampling Size and

TechniquesTechniquesInpatient RecordsInpatient RecordsOutpatient RecordsOutpatient Records

• Workload ComparisonWorkload Comparison• System SecuritySystem Security• System Design, System Design,

Development, Development, Operations, and Operations, and Education and TrainingEducation and Training

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Regulatory GuidanceRegulatory GuidanceDODI 6040.40DODI 6040.40

Military Health System Data Quality Management Military Health System Data Quality Management ControlControl ProceduresProcedures

Department of DefenseDepartment of Defense

INSTRUCTIONINSTRUCTION

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Regulatory GuidanceRegulatory GuidanceDODD 6040.41DODD 6040.41

Medical Records Retention and Coding at Military Medical Records Retention and Coding at Military Treatment FacilitiesTreatment Facilities


DIRECTIVEDIRECTIVE

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Medical Encounter and Coding at Medical Encounter and Coding at Military Treatment FacilitiesMilitary Treatment Facilities


DIRECTIVEDIRECTIVE

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Custody and Control of Outpatient Medical RecordsCustody and Control of Outpatient Medical Records


DIRECTIVEDIRECTIVE

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Custody and Control of Outpatient Medical RecordsCustody and Control of Outpatient Medical Records


DIRECTIVEDIRECTIVE

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Program ManagementProgram Management

• Data Quality ManagerData Quality Manager• Data Quality Assurance TeamData Quality Assurance Team• Intermediate Command DQ ManagerIntermediate Command DQ Manager• Service Data Quality ManagerService Data Quality Manager• DQMC Review ListDQMC Review List• Commanders Monthly Data Quality Commanders Monthly Data Quality

StatementStatement

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System Inputs, Processes, System Inputs, Processes, and Outputsand Outputs

• Composite Health Care System (CHCS)Composite Health Care System (CHCS)• Armed Forces Health Longitudinal Technology Armed Forces Health Longitudinal Technology

Application (AHLTA)Application (AHLTA)• Ambulatory Data Module (ADM)Ambulatory Data Module (ADM)• Medical Expense and Performance Reporting Medical Expense and Performance Reporting

System (MEPRS) / Expense Assignment System System (MEPRS) / Expense Assignment System (EAS)(EAS)

• Third Party Outpatient Collection System Third Party Outpatient Collection System (TPOCS)(TPOCS)

• MEPRS Early Warning and Control System MEPRS Early Warning and Control System (MEWACS(MEWACS))

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Data InputData InputMEPRS/EAS, ADM, CHCS, TPOCSMEPRS/EAS, ADM, CHCS, TPOCS

• Written ProceduresWritten Procedures• Current VersionsCurrent Versions• Upgrades & UpdatesUpgrades & Updates• Rejected RecordsRejected Records• End of Day Processing End of Day Processing

– Percentage of ClinicsPercentage of Clinics– Percentage of AppointmentsPercentage of Appointments

• Timely Coding Completion Timely Coding Completion

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Commander’sCommander’sData Quality StatementData Quality Statement

• Q. 1. In the reporting month:Q. 1. In the reporting month:– a) What percentage of clinics have a) What percentage of clinics have

complied with “End of Day” processing complied with “End of Day” processing requirements, “Every clinic – Every day? requirements, “Every clinic – Every day? (B.5.(a.))(B.5.(a.))

– b) What percentage of appointments b) What percentage of appointments were closed in meeting your “End of were closed in meeting your “End of Day” processing requirements, “Every Day” processing requirements, “Every appointment – Every day?” (B.5.(b))appointment – Every day?” (B.5.(b))

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• Q. 2. In accordance with legal and Q. 2. In accordance with legal and medical coding practices, have all of medical coding practices, have all of the following occurred:the following occurred:– a) What percentage of Outpatient a) What percentage of Outpatient

Encounters, other than APVs, have been Encounters, other than APVs, have been coded within 3 business days of the coded within 3 business days of the encounter? (B.6.(a))encounter? (B.6.(a))

– b) What percentage of APVs have been b) What percentage of APVs have been coded within 15 days of the encounter? coded within 15 days of the encounter? (B.6.(b))(B.6.(b))

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• Q. 2. In accordance with legal and Q. 2. In accordance with legal and medical coding practices, have all of medical coding practices, have all of the following occurred:the following occurred:– c) What percentage of Inpatient records c) What percentage of Inpatient records

have been coded within 30 days after have been coded within 30 days after discharge? (B.6.(c))discharge? (B.6.(c))

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Data OutputData OutputMEPRS/EAS, ADM, CHCS, TPOCSMEPRS/EAS, ADM, CHCS, TPOCS

• EASEAS– Financial Reconciliation Financial Reconciliation – Inpatient and Outpatient Workload Inpatient and Outpatient Workload

ReconciliationsReconciliations– MEWACS ReviewMEWACS Review– Timely Data TransmittalTimely Data Transmittal– Workload ComparisonWorkload Comparison

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

– a) Was monthly MEPRS/EAS financial a) Was monthly MEPRS/EAS financial reconciliation process completed?reconciliation process completed?

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

– b) Were monthly Inpatient and b) Were monthly Inpatient and Outpatient workload reconciliation Outpatient workload reconciliation processes completed?processes completed?


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

– c) Were the data load status, c) Were the data load status, outlier/variance, WWR-EAS IV, and outlier/variance, WWR-EAS IV, and allocations tabs in the current MEWACS allocations tabs in the current MEWACS document reviewed and explanations document reviewed and explanations provided for flagged data anomalies?provided for flagged data anomalies?

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• Q. 4. Compliance with TMA or Q. 4. Compliance with TMA or Service-Level guidance for timely Service-Level guidance for timely submission of data (C.3.).*submission of data (C.3.).*

– a) MEPRS/EAS (45 days)a) MEPRS/EAS (45 days)

**PASBA populates this response.PASBA populates this response.

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• CHCSCHCS– Duplicate RecordsDuplicate Records– Timely Data TransmittalTimely Data Transmittal

•Standard Inpatient Data Record (SIDR) Standard Inpatient Data Record (SIDR) •Worldwide Workload ReportWorldwide Workload Report

– Inpatient RecordsInpatient Records•AccountabilityAccountability•DocumentationDocumentation•CodingCoding•SIDRs completed (in a “D” status)SIDRs completed (in a “D” status)

– Workload ComparisonWorkload Comparison

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• Q. 4. Compliance with TMA or Service-Level Q. 4. Compliance with TMA or Service-Level guidance for timely submission of data guidance for timely submission of data (C.3.).* (C.3.).*

b) SIDR/CHCS (No later than b) SIDR/CHCS (No later than

55thth and 20 and 20thth calendar day of the month) calendar day of the month)

*PASBA populates this response. *PASBA populates this response.

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• Q. 4. Compliance with TMA or Service-Q. 4. Compliance with TMA or Service-Level guidance for timely submission Level guidance for timely submission of data (C.3.).*of data (C.3.).*

– c) WWR/CHCS (10c) WWR/CHCS (10thth calendar day calendar day following month)following month)

*PASBA populates this response.*PASBA populates this response.

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Commander’s Commander’s Data Quality StatementData Quality Statement

• Q.4. Compliance with TMA or Service-Q.4. Compliance with TMA or Service-Level guidance for timely submission Level guidance for timely submission of data (C.3).*of data (C.3).*

– d) SADR/ADM (daily)d) SADR/ADM (daily)

*PASBA populates this response.*PASBA populates this response.

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• Q. 5.a. Outcome of monthly inpatient Q. 5.a. Outcome of monthly inpatient coding audit: (C.5.(c,f))coding audit: (C.5.(c,f))

Inpatient Records (DRG) # Records Inpatient Records (DRG) # Records Reviewed:_________ % Correct Reviewed:_________ % Correct ______________

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Data OutputData OutputInpatient CodingInpatient Coding

• CodingCoding– DRG Codes DRG Codes – Related Data Elements (C.5)Related Data Elements (C.5)

• All DiagnosesAll Diagnoses

• Any ProceduresAny Procedures

• SexSex

• AgeAge

• Discharge/DispositionDischarge/Disposition

• Percentage of SIDRs Completed (D-Status)Percentage of SIDRs Completed (D-Status)

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• Q. 5.b. Outcome of monthly inpatient Q. 5.b. Outcome of monthly inpatient coding audit: (C.5.(c,f))coding audit: (C.5.(c,f))

IBWA Rounds encounters audited IBWA Rounds encounters audited and deemed correct?and deemed correct?

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• ADMADM– Timely Data TransmittalTimely Data Transmittal

•Standard Ambulatory Data Record (SADR)Standard Ambulatory Data Record (SADR)

– Error LogsError Logs– Workload ComparisonWorkload Comparison

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• Q.6. Outpatient RecordsQ.6. Outpatient Records

– a) Percentage of outpatient medical a) Percentage of outpatient medical records on-hand containing the records on-hand containing the documentation and/or the loose documentation and/or the loose documentation of the encounter documentation of the encounter selected to be audited or documented selected to be audited or documented as checked out? (C.6)as checked out? (C.6)

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Data OutputData OutputOutpatient CodingOutpatient Coding

• Sample SizeSample Size

• AccountabilityAccountability– Percentage Located or Properly Checked Percentage Located or Properly Checked

OutOut– Checked-out Over 30-Days?Checked-out Over 30-Days?

• DD Form 2569 (Third Party Insurance DD Form 2569 (Third Party Insurance Information)Information)

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• Q. 6. Outpatient Records.Q. 6. Outpatient Records.

– b) What was the percentage of E & M b) What was the percentage of E & M codes deemed correct? (E & M code codes deemed correct? (E & M code must comply with current DoD must comply with current DoD guidance.) (C.6.(b))guidance.) (C.6.(b))

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– c) What was the percentage of ICD-9 c) What was the percentage of ICD-9 codes deemed correct? (C.6.(c))codes deemed correct? (C.6.(c))

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– d) What was the percentage of CPT d) What was the percentage of CPT codes deemed correct? (CPT code must codes deemed correct? (CPT code must comply with current DoD guidance.) comply with current DoD guidance.) (C.6.(d))(C.6.(d))

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– e) What percentage of completed & e) What percentage of completed & current DD Form 2569s are maintained current DD Form 2569s are maintained in the record (non-active duty)? (C.6.(e))in the record (non-active duty)? (C.6.(e))

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– f) What percentage of completed & f) What percentage of completed & current DD Form 2569s in the medical current DD Form 2569s in the medical record were verified to be correct in the record were verified to be correct in the Patient Insurance file in CHCS? (C.6.(f))Patient Insurance file in CHCS? (C.6.(f))

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• Question 7 Ambulatory Procedure Question 7 Ambulatory Procedure Visits (C.7.a,b,c,d,e,f)Visits (C.7.a,b,c,d,e,f)

• Questions 7.a,b,c,d,e,f Are the same Questions 7.a,b,c,d,e,f Are the same as Questions 6.a,b,c,d,e,f as Questions 6.a,b,c,d,e,f

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• Q. 8. Comparison of reported workload Q. 8. Comparison of reported workload data (C.9).data (C.9).**

– a) # SADR Encounters / # WWR visitsa) # SADR Encounters / # WWR visits– b) # SIDR Dispositions / # WWR Dispositionsb) # SIDR Dispositions / # WWR Dispositions– c) # EAS Visits / # WWR Visitsc) # EAS Visits / # WWR Visits– d) # EAS Dispositions / # WWR Dispositionsd) # EAS Dispositions / # WWR Dispositions– e) # of IBWA SADR encounters (FCC=A***)/#Sum e) # of IBWA SADR encounters (FCC=A***)/#Sum

WWR (Total Bed Days + Total WWR (Total Bed Days + Total Dispositions) Dispositions)

*PASBA populates the numbers for these questions*PASBA populates the numbers for these questions..

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Data OutputData OutputWorkload ComparisonWorkload Comparison

• Question 8aQuestion 8a• SADR Encounters / WWR VisitsSADR Encounters / WWR Visits

– Should Have More Encounters Than VisitsShould Have More Encounters Than Visits– Encounters – Omit Appt. Status of “No-Encounters – Omit Appt. Status of “No-

Shows,” “Canceled,” and Disposition Code Shows,” “Canceled,” and Disposition Code “Left Without Being Seen”“Left Without Being Seen”

– Encounters – Include Appt. Status “TelCon”Encounters – Include Appt. Status “TelCon”– Only SADR Records in B*** and FBN clinics Only SADR Records in B*** and FBN clinics

that are marked with an Appt. Status of “C” that are marked with an Appt. Status of “C” (complete) Are To Be Included(complete) Are To Be Included

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• Question 8bQuestion 8b

• SIDR Dispositions / WWR DispositionsSIDR Dispositions / WWR Dispositions– Must MatchMust Match– Only SIDRs With a Disposition of Status Only SIDRs With a Disposition of Status

of “D” Are To Be Includedof “D” Are To Be Included– SIDRs – Exclude Carded for Record Only SIDRs – Exclude Carded for Record Only

(CRO) and Absent Sick Records(CRO) and Absent Sick Records

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• Question 8cQuestion 8c

• EAS Visits / WWR VisitsEAS Visits / WWR Visits– Must MatchMust Match– Include MEPRS Functional Cost Code B** Include MEPRS Functional Cost Code B**

(Outpatient) and FBN (Hearing (Outpatient) and FBN (Hearing Conservation)Conservation)

– Include APVsInclude APVs

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• Question 8dQuestion 8d

• EAS Dispositions / WWR DispositionsEAS Dispositions / WWR Dispositions– Must MatchMust Match– Only SIDRs with a Disposition Status of Only SIDRs with a Disposition Status of

“D” are to be included“D” are to be included

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# of IBWA SADR (RNDS appt type only # of IBWA SADR (RNDS appt type only encounters (FCC=A***)/ # SUM WWR encounters (FCC=A***)/ # SUM WWR

Bed daysBed days

• Question 8eQuestion 8e

• Industry Based Workload AlignmentIndustry Based Workload Alignment

• The capture of the inpatient The capture of the inpatient professional services is referred to as professional services is referred to as IBWA.IBWA.

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

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SecuritySecurity

• Responsibilities Formally Assigned?Responsibilities Formally Assigned?

• HIPAA ComplianceHIPAA Compliance– Password ProtectionPassword Protection– AccessAccess– ConfidentialityConfidentiality– Level of AccessLevel of Access

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System Design, Operations, System Design, Operations, and Education/Trainingand Education/Training

• System Administrator Appointed In Writing System Administrator Appointed In Writing for Each Systemfor Each System

• Training and Education Procedures and Training and Education Procedures and DocumentationDocumentation

• System Change Request ProcessSystem Change Request Process• System Incident ReportSystem Incident Report• Routine MaintenanceRoutine Maintenance• Points of Contact for Equipment Failure Points of Contact for Equipment Failure

IssuesIssues• Contingency PlansContingency Plans

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Data Quality Section, PASBAData Quality Section, PASBA Mr. Joseph (Tim) Bacon Chief DQ Section / Army DQ Mgr Telephone: (210) 295-8725 [email protected]

Ms. Deborah Lundberg Mr. Angel PadillaNARMC DQ Representative WRMC/ PRMC / 18th MEDCOM(210) 295-8923 DSN 421 DQ Representative (210) 295-8842

Mr. Joe Alley Ms. Vicki VestalSERMC/ ERMC GPRMC DQ RepresentativeDQ Representative (210) 295-8931(210) 221-0467 DSN 421

http://www.pasba.amedd.army.mil

mailto:[email protected]

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

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