1. “Medically Ready Force…Ready Medical Force” Data Quality Management Control (DQMC) Program DQMC Program Review List for FY 2016

2. DQMC Program Review List Agenda DQMC Program Background Review List Purpose Review List Overview New/changed Questions for FY16 Questions? 2 Unclassified

3. “Medically Ready Force…Ready Medical Force” 3 Memo dated November 2000 and signed by Acting Assistant Secretary of Defense Jarrett Clinton established DQMC Program for the MHS. The directing memo was sent to the three services Assistant Secretaries, with copies furnished the three services Surgeon Generals. Established the various components of the program (DQ Manager, DQ Assurance Teams, Review List, CDR’s monthly DQ Statement, Internal/External Audits). DQMC Program Background

4. “Medically Ready Force…Ready Medical Force” 4 DQMC Program Objectives To improve the overall quality of financial and clinical workload data. Command oversight to improve submission of complete, accurate, and timely data. Assure uniformity and standardization of information across the MHS. DQMC Program Background

5. “Medically Ready Force…Ready Medical Force” 5 Vector Check Documents DoDI 6040.40 DoDI 6040.40 Enclosure 1: Review List Dated 7 Aug 2012 Enclosure 2: Statement Dated 7 Aug 2012 Subset of Review List Signed by MTF Commander Submitted to higher HQ Your MTF’s results are posted word-for word on TMA’s website: http://www.tricare.mil/ocfo/mcfs/dqmcp/metrics_reports.cfm

6. “Medically Ready Force…Ready Medical Force” 6 Purpose DQMC Review List Assists MTF Commander in establishing and maintaining an effective DQMC Program. Completed Review List is reported monthly to Executive Committee and MTF Commander. Review List kept on file for 5 years. The Review List is an internal management control tool that contains the details behind the Monthly DQ Statement.

7. “Medically Ready Force…Ready Medical Force” 7 DQMC Review List – Section Overview A. Organizational Factors Leadership commitment and support are critical to assure the appropriate environment for data quality B. Data Input Controls in this category are designed to ensure data are entered into the application in an accurate, complete, and timely manner C. Data Output Data Output controls are used to ensure the accurate and timely distribution of outputs D. Security These controls should provide assurances that computers and the data they contain are properly protected against theft, loss, unauthorized access, and natural disaster E. System Design, Developmen t and Education and Training Intended to ensure that systems meet user needs, are developed economically, are thoroughly documented and tested, and contain appropriate internal controls

8. “Medically Ready Force…Ready Medical Force” 8 Review List Changes for FY16 A. Organizational Factors No changes in Organizational Factors Section

9. “Medically Ready Force…Ready Medical Force” 9 Review List Changes for FY16 B. Data Input Question B.5. Added question – What percentage of patient initiated Secure messages has been responded to within 1 business day?

10. “Medically Ready Force…Ready Medical Force” 10 Review List Changes for FY16 C. Data Output Question C.4. Modified question - Require MTF to identify errors and number corrected. Run the Ambulatory Data Module (ADM) Standard Ambulatory Data Report (SADR) / Comprehensive Ambulatory Patient Encounter Report (CAPER) Error Report and identify and correct the CAPER errors. Formula: Number of CAPER errors corrected / Number of CAPER errors

11. “Medically Ready Force…Ready Medical Force” 11 Review List Changes for FY16 C. Data Output Updated all references from ICD-9 to ICD-10. Question C.5.d. Added question – Percentage of ICD-10 PCS Codes audited and deemed correct? Formula: Number of correct ICD-10 PCS codes / Total number of ICD-10 PCS codes.

12. “Medically Ready Force…Ready Medical Force” 12 Question C.5.e. Added question – Percentage of ICD 10-CM codes audited and deemed correct? Formula: Number of correct ICD-10-CM codes / Total number of ICD-10-CM Codes Question C.8 Modified questions – All questions within this section C.8.a,b,c,d,e,f, have added “evidence of OHI discovery”, as another method of identifying beneficiaries with other health insurance; this is in addition to the traditional method of using the DD Form 2569. Review List Changes for FY16 C. Data Output

13. “Medically Ready Force…Ready Medical Force” 13 Review List Changes for FY16 C. Data Output The formula for the questions within section C.8. have been modified to remove the verbiage “DD Form 2569” and replaced with “OHI information Documents”. Question C.10.4. question on Total A*** CAPERs has had the Note changed to read; Valid E&M Codes are documented in the Coding Work Group paper “C.10 Data Quality Coding Error Reports: Valid A*** CAPER Rules.”

14. “Medically Ready Force…Ready Medical Force” 14 Review List Changes for FY16 C. Data Output Question C.11. a & b added questions - Incomplete CAPER Report (or Service equivalent, Includes APVs) (Goal is 100%). Metric should be refreshed and reported for each period through current data month. a) Formula: Number of CAPER encounters / number of Kept Appointments b) Formula: Prior FY Number of CAPER encounters / number of Kept Appointments

15. “Medically Ready Force…Ready Medical Force” 15 Review List Changes for FY16 C. Data Output Question C.12. a & b added questions - Incomplete SIDR Report (or Service equivalent, Includes APVs)(Goal is 100%). Metric should be refreshed and reported for each period through current data month. a) Formula: Number of SIDR dispositions / number of SIDR D and E status dispositions b) Formula: Prior FY Number of SIDR dispositions / number of SIDR D and E status dispositions

16. “Medically Ready Force…Ready Medical Force” 16 Review List Changes for FY16 D. Security No changes in Security Section

17. “Medically Ready Force…Ready Medical Force” 17 Review List Changes for FY16 E. System Design, Development and Education and Training No changes in Security Section

18. “Medically Ready Force…Ready Medical Force” 18 DQMC Program Review List Summary DQMC Program Background Review List Purpose Review List Overview New/changed Questions for FY16 Questions?

19. “Medically Ready Force…Ready Medical Force” 19 DQMC Program Review List