Health Budgets & Financial Policy 2009 UBO/UBU Conference 2009 UBO/UBU Conference Where the Pieces Come Together Date: March 31 Time: 1010 – 1200 Briefing: Coding Audit Results

2009 UBO/UBU Conference Where the Pieces Come Together Objectives Review the Results of the Coding Audit of FY2006 Records, including: – Response Rates – Percent Passing the Audit – Number of Errors Encountered – Types of Coding Errors Lessons Learned from the Audit Suggestions for Improvement

2009 UBO/UBU Conference Where the Pieces Come Together 2 Audit Goals ●Produce Service level estimates of the coding accuracy of Inpatient, Outpatient, and APV records during FY 2006 ●Provide feedback to MTFs to enable them to improve their medical coding ● Comply with DoD Directive of April 13, 2004 and DoD Instruction of June 10, 2004 ● Validate MHS costs of providing health care to Medicare- Eligible retirees at MTFs during FY 2006, (Medicare- Eligible Retiree Health Care Fund (MERHCF)).

2009 UBO/UBU Conference Where the Pieces Come Together 3 Audit Methods AuditType of Record Scope of RecordType of MTFNumber in Sample AnnualSIDRInpatientArmy700 AnnualSADROutpatient, Non-APVArmy700 AnnualSADRAPVArmy700 AnnualSIDRInpatientNavy700 AnnualSADROutpatient, Non-APVNavy700 AnnualSADRAPVNavy700 AnnualSIDRInpatientAir Force700 AnnualSADROutpatient, Non-APVAir Force700 AnnualSADRAPVAir Force700 MERHCFSIDRInpatientMHS wide400 MERHCFSADROutpatientMHS wide400 Audit Samples 11 random samples of FY 2006 medical records drawn from across the direct care system Total audit size = 7100; SADRS from 276 MTFs; SIDRs from 64 MTFs

2009 UBO/UBU Conference Where the Pieces Come Together Outpatient Results

2009 UBO/UBU Conference Where the Pieces Come Together 5 Our goal was an 85% response rate

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together 9

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together The Most Common E&M Errors in Records that Failed the Audit OutpatientArmyNavyAir Force E&M not required14.39%10.20%9.57% TCON coded as office visit12.50%11.22%25.53% APVArmyNavyAir Force None* MERHCFArmyNavyAir Force TCON coded as office visit32.10%14.75%11.11% E&M not required9.88%6.56%3.70% * None of the services had more than 1% of failed APV records with any E&M error.

2009 UBO/UBU Conference Where the Pieces Come Together The Most Common Diagnosis Errors in Records that Failed the Audit

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together Inpatient Results

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together

2009 UBO/UBU Conference Where the Pieces Come Together 20 “Failed’ Criteria is not limited to incorrect DRG

2009 UBO/UBU Conference Where the Pieces Come Together “Failed’ Criteria is not limited to incorrect DRG

2009 UBO/UBU Conference Where the Pieces Come Together Quality Assurance 22 Percent Agreement Inter-examiner Reliability (Agreement between the Study Auditor and a Reference Auditor) Agreement SIDR 93.42% SADR 96.35% Percent Agreement for Intra-examiner Reliability (Agreement between the Study Auditor and themselves) Agreement SIDR 96.49% SADR 97.65%

2009 UBO/UBU Conference Where the Pieces Come Together Summary Reviewed the Results of the Coding Audit of FY2006 Records, including: – Response Rates – Percent Passing the Audit – Number of Errors Encountered – Types of Coding Errors Lessons Learned from the Audit Suggestions for Improvement

2009 UBO/UBU Conference Where the Pieces Come Together Speaker Information