Excellent Healthcare, Clinical Currency Air Force Medical Operations Agency Air Force TMA DQ Course Break-Out Session 1 AFMOA/SGAR Sept 2010

Excellent Healthcare, Clinical Currency 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 2

Excellent Healthcare, Clinical Currency Organization HAF/SG8Y (policy)AFMOA (execution) Chief, Financial Performance Program Manager AF Interim DQ Manager Program Analyst DQ Subject Matter Expert 3

Excellent Healthcare, Clinical Currency 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 4

Excellent Healthcare, Clinical Currency AFMOA/SGAR 5 Chief, Resource Management Division Chief, Resource Operations Branch MEPRS Director Data Quality Director UBO Director Deputy Chief, Resource Operations Branch

Excellent Healthcare, Clinical Currency Integrated Approach 6 MEPRS Personnel Workload Financial UBO Other Health Insurance Eligibility Demographics Coding SIDR/SADR MSDRG/RWP RVU/CPT Patient & Provider Data Quality

Excellent Healthcare, Clinical Currency DQ Program Manager Mr. Powers DQ Program Manager Mr. Powers DQ Program Analyst Ms. Gifford DQ Program Analyst Ms. Gifford DQ SME Mrs. Stretch-McClain DQ SME Mrs. Stretch-McClain DQ SME Mrs. Leonard DQ SME Mrs. Leonard Data Quality (DQ) Roles and Responsibilities - 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 - 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 Mission: - Provide Comprehensive DQ - Program Management to all MTFs - Provide reachback support to MAJCOMs and DRUs Mission: - Provide Comprehensive DQ - Program Management to all MTFs - Provide reachback support to MAJCOMs and DRUs Key Objectives: - Standardize Methodology - Evaluate Processes - Reduce Variance Key Objectives: - Standardize Methodology - Evaluate Processes - Reduce Variance Future Initiatives: - Consolidation - Shape MHS/AFMS DQ efforts - Field Electronic DQ Statement Future Initiatives: - Consolidation - Shape MHS/AFMS DQ efforts - Field Electronic DQ Statement

Excellent Healthcare, Clinical Currency MTF DQ Engagement One-on-one support Telephone 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 CY10 on Vector Check DCO is the primary tool used to conduct meetings and take attendance

Excellent Healthcare, Clinical Currency Defense Connect Online Find meeting here Meetings found will be shown here. To become a registered user visit:

Excellent Healthcare, Clinical Currency 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.

Excellent Healthcare, Clinical Currency

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

Excellent Healthcare, Clinical Currency 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) membership before you can access Vector Check Once you have obtained a Kx membership, and are still unable to access Vector Check, contact AFMOA Include your name, , and DSN Turnaround time is hours Visit the AMFOA DQ site at:

Excellent Healthcare, Clinical Currency Vector Check Alerts 14 Click on your name.

Excellent Healthcare, Clinical Currency Vector Check Alerts 15 Click on My Settings.

Excellent Healthcare, Clinical Currency Vector Check Alerts 16 Click on My Alerts.

Excellent Healthcare, Clinical Currency Vector Check Alerts 17 Click on Add Alert.

Excellent Healthcare, Clinical Currency Vector Check Alerts 18 Select which item you would like to be alerted to when new information is posted. After selection is made click on next.

Excellent Healthcare, Clinical Currency Vector Check Alerts 19 Select criteria of the alerts you want to be notified on. After selection is made click on OK.

Excellent Healthcare, Clinical Currency Vector Check Alerts 20 This will show you what alerts you are signed up for. Follow this process for each alert.

Excellent Healthcare, Clinical Currency Vector Check RM Master Roster Vector Check RM Master Roster Updates 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 21

Excellent Healthcare, Clinical Currency Vector Check RM Master Roster 22 Click on Resource Management Master Roster Updates

Excellent Healthcare, Clinical Currency Vector Check RM Master Roster 23 Click on Installation Name and then click on your base

Excellent Healthcare, Clinical Currency Adding a New POC 24 Click on New and then click on New Item

Excellent Healthcare, Clinical Currency 25 Input all information and then click OK Adding a New POC

Excellent Healthcare, Clinical Currency Editing a POC 26 Click on Actions and then click on Edit in Datasheet

Excellent Healthcare, Clinical Currency Editing a POC 27 Click on Installation Name and then click on your base

Excellent Healthcare, Clinical Currency Editing a POC 28 Type over any line item that needs to be fixed For positions not filled, ttype vacant for last name

Excellent Healthcare, Clinical Currency What is available on Vector Check?

Excellent Healthcare, Clinical Currency 30 Why is Data Quality Important? To accurately reflect the work performed in your MTF

Excellent Healthcare, Clinical Currency MTF Patient Accounting & Revenue Cycle Results are increased resourcing with reliable outcomes in the form of usable data Improved patient access, records documentation and coding accuracy 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 CHCS (Files & Tables) MEPRS (MEWACS) MTF Business Plan (Patient Management) Resourcing (Money, Manpower, and Materiel) Patient Access Contract Mgmt Payer Education Appeals Payment Posting Denial Mgmt Account Follow-up Claims Coding UR/UM Referral Mgmt Pre-cert/ Auth Encounter Document Patient Check-in Ins Verify & Auth Production Value (RVUs/RWPs) Data Quality Management ADM/ P-GUI/ CHCSII EWRAS CCE TPOCS/ CMBB Electronic Billing M2 Data Mart Cost per RVU/RWP (Efficiency)

Excellent Healthcare, Clinical Currency 32 DQ System Architecture Air Force MDR M2 WWR (Count Visits) EAS IV “Eligible” Encounters CPT Codes Units of ServiceWAM Count Visits & Raw Services SADR CAPER (Encounters) TPOCS Billable Encounters PDTS Worldwide Workload Report Standard Ambulatory Data Record EAS Repository EAS IV Extract MHS Data Repository MHS Mart Service Repository (BDQAS) Pharmacy Data Transaction System Pop Health Portal CCE Coding Compliance Editor Clinical Data Mart TRICARE Ops Center Interface Errors DoD/VA FHIE/BHIE SHARE AD M SADR 1/SADR 2 Essentris CCQAS

Excellent Healthcare, Clinical Currency 33 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

Excellent Healthcare, Clinical Currency 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 34

Excellent Healthcare, Clinical Currency HSI Requirements Data Quality Manager appointment letter Commander’s DQ Statements (previous 12 months) DQ Assurance Team meeting minutes (previous 2 years). The MTF/CC appointed a DQ Manager who is responsible for accomplishing Data Quality Management Control (DQMC) activities Completes the DQMC Review List and briefs results to the MTF Executive Committee A DQ Assurance Team was established (or an existing structure was tasked) 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, and GPMs MEPRS data was reconciled and validated prior to entry into EAS

Excellent Healthcare, Clinical Currency 36 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

Excellent Healthcare, Clinical Currency 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:

Excellent Healthcare, Clinical Currency 38 DQ TUG Format 8d. Number of EAS (Expense Assignment System) dispositions divided by the number of WWR (Worldwide Workload Report) dispositions?

Excellent Healthcare, Clinical Currency 39 Workload Guidelines Sample Encounter Activity Provider Type Provider Specialty Code MEPRS Code for Time Capture MEPRS Code for Workload Count/Non- Count indicator Patient Encounter Business Rules Coding Required Billing Required Nutritionist/ Dietitian Privileged Provider Dietician/ Nutritionist B*** CountRegistered dieticians or licensed nutrition Professionals are responsible for providing medical nutrition therapy (MNT). Yes - Supplements AF Coding Guidelines - Published by AF Coding Experts

Excellent Healthcare, Clinical Currency Best Practices Current Best Practices Posted on Vector Check Excel version of the TUG FY 10 DQMC Review List 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

Excellent Healthcare, Clinical Currency 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, and Group Practice Managers 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

Excellent Healthcare, Clinical Currency 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.

Excellent Healthcare, Clinical Currency DQ Assurance Team Initiatives - 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 43

Excellent Healthcare, Clinical Currency 44 DQ Assurance Team Initiatives - Interest Items (cont) Patient safety CHCS Training Accountability Improve data accuracy Include critical data elements Correct critical data elements Capture workload and revenue opportunities

Excellent Healthcare, Clinical Currency 45 Provider File Correction Process Central DSS Provider File pull with a focus on recent activity (1 APR 07 to Today) 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”

Excellent Healthcare, Clinical Currency 46 CHCS Provider File Report Cards

Excellent Healthcare, Clinical Currency 47 Provider Details Report

Excellent Healthcare, Clinical Currency 48 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 Facility700 Small Facility300 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

Excellent Healthcare, Clinical Currency CHCS Provider File Errors and Error Criteria (example) 49

Excellent Healthcare, Clinical Currency 50 AFMOA CHCS Provider File Resolution Guide Guide is available on Vector Check Description of each provider field Correction instructions CHCS screen shots CHCS menu path/secondary menu information CHCS maintenance reports Potential impact Recommended Office of Primary Responsibility Training Slides also available to supplement Resolution Guide Error correction and prevention

Excellent Healthcare, Clinical Currency 51 Outside Provider Entry Checklist

Excellent Healthcare, Clinical Currency 52 Provider File Progress Chart Provider File Progress Chart can be found at: Click Performance Measures ( Metrics) then Provider File Progress Charts The Provider File Progress Chart is based on a Microsoft Excel pivot table. This particular chart reflects the percentage of entries with errors. This information was taken directly from the provider report cards that were generated for each site since Nov Within the chart you can filter on the one or a combination of the following fields in order narrow the criteria to just your facility or to compare your facility with others. Facility Type (Peer Group) MAJCOM Base Data Month (Report Month)

Excellent Healthcare, Clinical Currency 53 Provider File Progress Chart

Excellent Healthcare, Clinical Currency Facility Type Filtering 54 To filter one Facility Type (peer group) click the arrow and select the facility type you want to view. This will automatically update the chart. **NOTE** To select more than one type check the “Select Multiple Items” box. Uncheck (ALL) then check the Types you wish to view.

Excellent Healthcare, Clinical Currency MAJCOM Filtering 55 To filter one MAJCOM click the arrow and select the MAJCOM you want to view. You can filter on this field only or within another filter, (small clinic is shown in this example). This will automatically update the chart. **NOTE** To select more than one MAJCOM check the “Select Multiple Items” box. Uncheck (ALL) then check the MAJCOMs you wish to view.

Excellent Healthcare, Clinical Currency Base Filtering 56 To filter one or multiple bases, click the arrow and select the bases you want to view. Uncheck (Select All), then check the bases you wish to view. NOTE: All Bases are shown in the pick list. However be aware if you are using multiple filters, your selected clinic must fall into the same category as those filters or it will not appear on your chart. EXAMPLE: Shown there is a filter on Facility type of Small Clinic and a filter on MAJCOM of AETC. If you now select Shaw as your base the chart would be blank because Shaw is a Small Clinic but falls under the MAJCOM of ACC not AETC.

Excellent Healthcare, Clinical Currency 57 Provider File Way Ahead Active ongoing support of MTF improvement efforts Further refine approach based on MTF feedback Enhance tool documentation Increased reporting frequency (monthly vs. quarterly) Share reports with MTF Leadership AFMOA UFR to centrally procure HCIdea website subscription for MTFs to support their correction efforts, $50K annually

Excellent Healthcare, Clinical Currency Current Data Quality Efforts 58 AFMOAAMCAFMSADHIMSMHS Function:Comprehensive CHCS Clean-up CHCS Patient File Clean-up - SME Support - Training Auto Merge Duplicate Patient CHCS/AHLTA using COTS Enterprise Wide Scheduling & Registration Sys Role:ID/Facilitate/PreventID/Fix/Prevent Prevent Contractor:PSI (prime) Smartronix/Evolvent (subs) Smartronix SAIC Issues:- 2 FTEs - Executed final option year – ends 28 SEP 11 - Flexible - 4 FTEs - Exp 15 DEC 10, +1 option yr - Linked Functionally to AFMSA Contract - 10 FTEs onsite yr, ends 27 SEP 10, 6-mo extension working - Revisit FY12 POM grade/$ -1 yr - Eliminate dup patient backlog - Design/build/test - Behind Schedule - System deployment may be at risk Proposal:- Continue to develop & mature - Tackle all K requirements - Consolidate with AFMOA DQ K - Reprogram $ from AMC to AFMOA - Transition to AFMOA oversight if funding provided - Support as AF Functional Rep - Ensure AF efforts complement - Continue to monitor and adjust efforts accordingly All CHCS Files Patient File Related

Excellent Healthcare, Clinical Currency Patient Registration DQ Team

Excellent Healthcare, Clinical Currency Patient Registration DQ Team (cont)

Excellent Healthcare, Clinical Currency Patient Registration DQ Team (cont)

Excellent Healthcare, Clinical Currency Automating Duplicate Patient Merge (ADPM) Initiative

Excellent Healthcare, Clinical Currency ADPM Initiative (cont)

Excellent Healthcare, Clinical Currency ADPM Initiative (cont) - Theater Medical Data System (TMDS) - AHTLA/CDR - CHCS

Excellent Healthcare, Clinical Currency Refining/expanding beyond DQ statement…TUG Internal tool to assist in identifying and correcting financial and clinical workload data problems Monthly Requirement All variances should be briefed with DQ Team and Executive Committee DQMC Review List is required to have all supporting summary documentation kept on file for five years eDQ will be based on the Review List MTFs need back up plans for Data Quality and all other areas that support completing the Review List. DQ Review List/Statement Reminders

Excellent Healthcare, Clinical Currency DQ Review List/Statement Reminders The due date is NLT the 25 th of the month. If the 25 th falls on a weekend, please have statement submitted the Friday prior Submitted Spreadsheet to AFMOA should match exactly what the CC signed The coding audit due dates changed in April. The audit previously was due approximately the 20 th of each month but now is due approximately on the 15 th of each month The auditors still have over a month to complete the audit Timeliness and Accuracy Metric

Excellent Healthcare, Clinical Currency

Do not use ‘see item above’ Must have problem, corrective action plan, and estimated completion date (include trouble tickets, if applicable) Clear and concise Required all areas in red and yellow and if 3c or 3d is under 100% Please check spelling on comments, numerous typos on many Don’t use “I” since the CC is signing the Statement, it would infer that the CC couldn’t get a task complete Comments included on your MTF Statement are posted word for word on TMA and vector check websites Upwards trend of comments not being related to question I.e.. Inpatient comments given for outpatient question (vice versa) DQ Review List/Statement Comments

Excellent Healthcare, Clinical Currency 69 DQ Review List DQ Assurance Team Meeting Question A.3. The DQ Assurance Team or other designated structure met during the reporting month to complete the DQ Management Control Review List. (Recommend attaching meeting minutes). “Yes” = Green “No” = Red (comments required) Do not use N/A

Excellent Healthcare, Clinical Currency 70 DQ Review List Executive Committee Brief Question A.4. The DQ Manager briefed the reporting month’s DQ Management Control Review List, and Financial and Workload Data Reconciliation and Validation results to the MTF Executive Committee. “Yes” = Green “No” = Red (comments required) Do not use N/A