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Air Force TMA DQ Course Break-Out Session. AFMOA/SGAR Mar 2011. Air Force TMA DQ Course Break-Out Session Overview. Organization MTF Engagement Why is DQ Important? HSI Requirements Resources DQ Assurance Team CHCS Provide File Other DQ Efforts DQ Review List/Statement Completion.
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Air Force TMA DQ Course Break-Out Session AFMOA/SGAR Mar 2011
Air Force TMA DQ Course Break-Out Session Overview Organization MTF Engagement Why is DQ Important? HSI Requirements Resources DQ Assurance Team CHCS Provide File Other DQ Efforts DQ Review List/Statement Completion
AFMOA Goals Patient-centered healthcare Currency platforms supporting innovative en route care and deployed medical ops Progressive reduction of waste in healthcare ops Precise application of resources to requirements
AFMOA/SGAR • Chief, Resource Management Division • Chief, Resource Operations Branch • MEPRS Director • Data Quality Director • UBO Director
Integrated Approach • MEPRS • Personnel • Workload • Financial Data Quality Data Quality • Patient • & • Provider • Coding • SIDR/SADR • MSDRG/RWP • RVU/CPT • UBO • Other Health Insurance • Eligibility • Demographics Data Quality Data Quality
Data Quality (DQ) Roles and Responsibilities • DQ Program Manager • Mr. Powers • DQ Program Analyst DQ SME • DQ SME • Provide CHCS Database Admin SME support • -- ID & assist MTFs correct: (Provider File errors, Hospital Location Files, • site definable MEPRS tables, clear incomplete ancillary results • Create CHCS restrictions/draft business rules to promote standardization • Develop CHCS training guides to promote MTF Data Quality • Provide Ad Hoc report assistance to support MTF data pulls • Perform MTF site visits to provide on-site technical assistance • Develop performance metrics to validate improvement efforts • Focal point for MTF’s DQ Mgmt • Control Program/DQ Statement • Teams to provide policy/MTF’s • business practice improvements • Biometric data consultant • Measures MTF/AFMS DQ • performance & influences change • - Trains MTF DQ Managers • Mission: • Provide Comprehensive DQ - Program Management to all MTFs • Provide reachback support to MAJCOMs and DRUs • Key Objectives: • Standardize Methodology • Evaluate Processes • Reduce Variance • Future Initiatives: • Consolidation • Shape MHS/AFMS DQ efforts • Field Electronic DQ Statement
MTF DQ Engagement • One-on-one support • Telephone • E-mail: firstname.lastname@example.org • Defense Connect Online (DCO) • Similar to “Go to Meeting” • MTF-AMFOA DQ Telecons every other month • PACAF, CONUS, USAFE • Business and training conducted • Schedule for CY11 on Vector Check • DCO is the primary tool used to conduct meetings and take attendance
Defense Connect Online Find meeting here Meetings found will be shown here. • To become a registered user visit: https://www.dco.dod.mil
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.
MTF DQ Engagement (cont) • AF portion of the TMA DQ Course • Other training/interaction forums: • Annual RMO Conf, UBO/U Conf, etc…. • Site 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
MTF DQ Engagement (cont) • 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 POC • 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
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Vector Check RM Master Roster • Vector Check RM Master Roster Updates • https://vc.afms.mil/AFMOA/SGA/SGAR/default.aspx • The following positions are the individuals we need updated: • MDG Commander • MDG Deputy Commander • MDSS Commander • Administrator • RMO • RMO NCOIC • DQ Manager • DQ Alternate • Recommend that Budget Analyst, MEPRS, and UBO staff update their primary and alternate information
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Why is Data Quality Important? To accurately reflect the work performed in your MTF
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
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
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
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
HSI Requirements • DOCUMENT LIST • Data Quality Manager appointment letter • Commander’s DQ Statements and DQMC Review List (previous 12 months – DoDI 6040.40 requires these be maintained for the previous 5 years). • DQ Assurance Team meeting minutes (previous 2 years). • ELEMENT 3.2.2. CHECKLIST • The MTF/CC appointed a DQ Manager and Alternate who are responsible for accomplishing DQMC activities • Completes the DQMC Review List monthly • DQ Manager briefs DQMC Review List and Financial and Workload Data Reconciliation and validation results monthly to the MTF Executive Committee
HSI Requirements • A DQ Assurance Team was established (or an existing structure was tasked) and met monthly 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, GPMs, and Patient Administration • DQAT developed/monitored corrective action plans for all negative findings on the DQMC Review List • Maintain DQMC summary supportive documentation for all DQMC Review List questions
DQ Toolkit…a.k.a. Vector Check “Think of Vector Check as your DQ Toolkit” – key components in your toolkit: • Data Quality Team User Guide (DQ TUG) • 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
DQ TUG • Primary AF Specific DQ Guidance • DQ Statement clarification • TUG focuses on DQ Review List vs. Statement (prep for eDQ) • Formulas/background info/how to get the data • Share TUG with your entire DQ team • Discuss TUG at your DQ meeting to ensure it is read and understood by those answering DQ Statement and Review List questions • Living document...updated during the year as needed • Published by HAF DQ • DQ TUG Sample:
Resources DQ TUG Format 8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions?
Workload Guidelines Sample • Supplements AF Coding Guidelines • - Published by AF Coding Experts • MHS Coding Guidelines, inpatient and outpatient, dated 1 January 2011 • http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm
Best Practices • Current Best Practices Posted on Vector Check • Excel version of the TUG to include FY11 DQMC Review List and Statement in Excel Format • Sample DQ Agenda and 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
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, Group Practice Managers, and Patient Administration • Although not a requirement, recommend a coder/coding auditor, ancillary services representative, and all respective Defense Medical Human Resources System – internet (DMHRSi) personnel (ie. DMHRSi Manager, contract liaison, civilian liaison, volunteer liaison, and Command Support Staff (CSS) personnel), UBO Manager, and clinic support staff representative attend meetings
DQ Assurance Team • Provide oversight of the provider file clean-up and maintenance, TMA coding audit, MEPRS Account Subset Definitions (ASD) reconciliation and use, DMHRSi program, DD Form 2569 collection process, and any other DQ issues. • Develop DQ initiatives • Communication, ensure there is cross-talk. Recommend at your next DQ meeting, that everyone goes around the room and understands why they are a member of the team, what role they have in DQ, and what ideas they have to make the team (ultimately your MTF) better.
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
DQ Assurance TeamInitiatives - Interest Items (cont) • Patient safety • CHCS Training • Accountability • Improve data accuracy • Include critical data elements • Correct critical data elements • Capture workload and revenue opportunities
Provider File Correction Process • Central DSS Provider File pull with a focus on recent activity • 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”
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