data quality management control program (dqmc)
DESCRIPTION
Data Quality Management Control Program (DQMC). Air Force Data Quality Program Manager. Overview. Data Quality (DQ) Program Systems DQ Composite Health Care System (CHCS) Initiatives FY09 Updates Take Away Questions. Data Quality Manager Data Quality Assurance Team DQMC Review List - PowerPoint PPT PresentationTRANSCRIPT
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Data Quality Management Control Program (DQMC)
Air Force Data Quality Program Manager
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Overview
Data Quality (DQ) ProgramSystemsDQ Composite Health Care System (CHCS)
InitiativesFY09 UpdatesTake AwayQuestions
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DQMC Program
Data Quality Manager
Data Quality Assurance Team
DQMC Review List
Data Quality Statement
INSTRUCTION
Department of Defense
DODI 6040.40Military Health System
Data Quality Management Control Procedures
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DQ Team Roles and Responsibilities
Team Key Players DQ Manager Resource Management Office (RMO) Group Practice Manager (GPM) Medical Expense and Performance Reporting System (MEPRS) Credentials Manager Budget Analyst/Uniform Business Office (UBO) Coding/Billing Supervisor Clinical Systems Administrator(s)
It is great to look – But are you working toward improvement?
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DQ Team Roles and Responsibilities
DQ team meets monthly
Review Metrics/Compliance Issues Provide deficiency correction plan and estimated
completion date (if applicable) Report monthly to Executive Committee Keep meeting minutes for at least two years Keep Review Lists for five years
It is great to look – But are you working toward improvement?
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DQ Team Responsibilities Cont…
DQMC Review List Maintained locally Tool to assist Military Treatment Facilities (MTFs) in
identifying and correcting financial and clinical workload data problems monthly
Data Quality Statement Facility Report Card Specific information from the DQMC Review List Commander signs/approves monthly Forwarded through the regional office to AF DQ
Manager AF summary submitted to DQMC
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Air Force
DQ System Architecture
MDRMDR
M2M2
WWR(Count Visits)
EAS IVEAS IV“Eligible” Encounters
CPT Codes Units of Service
WAMWAMCount Visits & Raw Services
SADR(Encounters)
TPOCSTPOCSBillable
Encounters
PDTSPDTS
Worldwide Workload Report
Standard Ambulatory Data Record
EAS Repository
ADMExtract
MHS Data Repository
MHS Mart
Service Repository (BDQAS)
Pharmacy Data Transaction System
Pop HealthPortal
CCE
Coding Compliance Editor
ClinicalData Mart
TRICAREOps Center
DoD/VA SHARE
SADR 1/SADR 2
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“E” – Support “D” – Ancillary “A” – Inpatient “B” – Outpatient “C” – Dental
+ “F” – Special Programs
+ “G” – Readiness
EAS IVMoney
Manpower
Workload
CRIS
EAS-SA
CHCS / WAM
(Count only)
RECONCILE
Direct Care “Step Down”
Medical Expense and Performance Reporting System“MEPRS” -- Valuation
Defense Health Program Cost Accounting
OUTPUT
TotalCost
RVUs RWPs
ICD/E&M/CPTDRGsSIDR
SADRCHCS
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MHS Management Analysis and Reporting Tool (M2) Used to extract data for PPS and AF Business Plan Need to identify the M2 user and alternate in your
facility TMA WISDOM course
EASIV Repository MEPRS data
Cost per data 45 day processing period for current month
MEPRS Manager TMA MADI Course
DQ Monitoring Tools
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Sample use of M2
M2 Query:
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MEPRS Early Warning and Control System (MEWACS) Trend analysis tool Usage monitored by DQMC Outlier indications
Review and correct data accordinglyOutliers are not always incorrect data
DQ Monitoring Tools Cont…
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BDQAS Ambulatory and Inpatient Metrics
FY “Point-in-time" Comparison Reports Updated on the 20th of the month Display by MTF or MAJCOM
MTF Rankings, Transmission Reports (daily/summary), Top DRG, "Principal" Diagnosis and Procedure Reports, E&M by Provider Specialty
Data Quality Statement Reports Compare and report values on DQ statement Consistent reporting for questions: 1a-b, 2a-b,
4b-d, 8a-d, 9
DQ Monitoring Tools Cont…
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BDQAS
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BRAC Monitor efficiency of the healthcare system Performance Based Budgeting – 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
How is your data used?
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Provider File
Civilian (Outside) Provider File Pharmacy/Lab/Rad are required to add the Civilian
Provider to CHCS. Is there a local policy? Create a local policy/standard operating procedure Educate and train the ancillary staff Use correct PSC linked to HIPAA Taxonomy
Provider naming convention, NPI, and DEA/License number should be strictly enforced and monitored Last Name/First Name, Middle Name or Initial (if available) Example: Smith / Johnson,S / Provider / Outside Provider Recommend subscribing to HCIdea to research
NPI/DEA/License # ; http://www.hcidea.org/
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Provider Profiles (con’t)Incorrect fields in red:PROVIDER: SMITH, JOHN R Name: SMITH, JOHN RProvider Flag: PROVIDERProvider ID: Provider1234NPI Type/ID: Provider Class: DocPerson Identifier: 123-45-6789Person ID Type Code: Select PROVIDER SPECIALTY: 517 (DENTAL CONSULTANT)Primary Provider Taxonomy:CMAC Provider Class: -Select PROVIDER TAXONOMY:HCP SIDR-ID:Location: CHAMPUS SUPPORT Class: OUTSIDE PROVIDER Initials: JRS SSN: 123-45-6789 DEA#: 99999999License #:
Corrected fields in red:PROVIDER: SMITH,JOHN R Name: SMITH,JOHN R Provider Flag: PROVIDERProvider ID: SMITHJRNPI Type/ID: 01/0125899Provider Class: OUTSIDE PROVIDERPerson Identifier: Person ID Type Code: Select PROVIDER SPECIALTY: 001 (FAMILY PRACTICE PHYSICIAN)Primary Provider Taxonomy: 207Q00000XCMAC Provider Class: -Select PROVIDER TAXONOMY:HCP SIDR-ID:Location: CHAMPUS SUPPORT Class: OUTSIDE PROVIDER Initials: JRSSSN: 123-45-6789 (Not Mandatory)DEA#: BM1212127 License #:
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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
Potential Revenue Impact
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Enter Provider Specialty Code (Be specific – not general) All PA’s – Provider Specialty Code 901 All Technicians – Provider Specialty Code 900 Independent Duty Medical Technician – Provider
Specialty Code 521 Lost revenue for codes 500 – 518 and 910 – 999
Zero workload RVU Prevent Encounter from flowing to TPOCS Impact on PPS
Provider Specialties 910 and above are Clinical Services
Provider Specialty Codes
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Value of Care PEDIATRICS – BDA Provider Specialty Code = 040
Pediatrician Diagnosis Codes
204 Lymphoid Leukemia 112.89 Candidial Endocarditis
Procedure Code 90780 Intravenous infusion for
therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour
90781 – Each additional hour E&M Code
99214 – Level 4 Established Patient OHI – Yes CMAC Value = $130.73 Class 1 Provider Will you bill for this patient? Yes
Reimbursement - $130.73 PPS RVU = 1.44 Reimbursement = $106.56
PEDIATRICS – BDA Provider Specialty Code = 949
Pediatrics Diagnosis Codes
204 Lymphoid Leukemia 112.89 Candidial Endocarditis
Procedure Code 90780 Intravenous infusion for
therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour
90781 – Each additional hour E&M Code
99214 – Level 4 Established Patient OHI – Yes CMAC Value = UNKNOWN Will you bill for this patient? NO
Reimbursement $0 PPS Workload = ZERO!!!!!!ZERO!!!!!!
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Today’s Situation
Lack of CHCS Provider File Training More accountability needed Potential for fraudulent billing Inaccurate Data
Missing Critical Data Elements Incorrect Critical Data Elements
Loss of workload and revenue opportunities
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AF CHCS DQ Initiative
Contract awarded Sept 06 Hired 2 contractors Review and analyze CHCS File and Table Build
Provider FileProvide functional and technical guidanceSite Analysis Report (SAR)
Establish CHCS DQ standardsProcess ownership of data elementsPolicies, business rules, and AFMS
standardization (CHCS DQ Continuity Handbook)
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AF CHCS DQ Initiative Cont…
MTF Reporting Requirements Monthly Data Quality Statement SADR/CAPER Write Back Error Report
Data due Monthly on the 5th to Air Staff All Provider Report
Data due Quarterly on the 15th to Air StaffWorkbook is preparedSite Analysis Report (SAR) provided back to
MTFMTF corrects errorsPerformance Metrics
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AFMS –CHCS Provider File % of Total Data Element Errors
By Error Type
Cycle
Error Type 1st 2nd 3rd 4th
SSN or Pseudo SSN 18,635 5,443 3,827 47,833
Generic Provider 2,466 2,918 2,200 11,292
Improper Signature Class 21,074 23,711 18,844 15,962
No DEA # 41,616 53,555 36,061 25,081
Provider Duplicate 8,479 10,599 6,565 6,487
Improper Naming Convention 46,257 53,099 29,458 20,019
# Provider Signature Classes Used 2,685 2,762 2,294 2,032
# Hospital Locations used for Providers 2,902 3,133 2,916 2,607
Total Errors 144,114 155,220 102,165 131,313
Total Elements Reviewed 2,800,616 3,060,656 3,087,072 2,774,672
% of Total Errors 5.15% 5.07% 3.31% 4.73%
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Sample of a SAR
1.High-level Discoveries 2.Key Activities Review and Assessment Results3.Icons
Downward trend No change Upward trend
Activities Description Potential Impacts DQ Finding Rating
Provider Specialty Code
Validate all Provider Codes are mapped specific to provider’s area of expertiseValidate all PA’s – Provider Specialty 901 Validate all Nurses (RNs) – Provider Specialty Code 600Validate Technicians – Provider Specialty Code 900Certify no providers are mapped in the code ranges 910-999 and 500-518
- PPS-TPOCS claims-MTFs Business Plan
1445
Name Field Validate the proper naming convention structureValidate duplicate provider namesReview generic provider names
-TPOCS claims 1001 Social Security Number (SSN)
Validate required 9-digit field for internal providersReview pseudo SSN
-TPOCS claims 130
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DQ Tool Kit
Data Quality Statement Guide Reporting Consistency Training document for new personnel
CHCS DQ Continuity Handbook, Version 2 CHCS Standardized Business Rules
FY08 Workload Guidelines Version 2.0 in final draft Brings together DQ, MEPRS, Coding and Billing AF supplemental guidance to DOD coding
guidelines
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CHCS DQ Initiative Roadmap
1st Quarter Provider File Submission
2nd Quarter Provider File Submission
3rd Quarter Provider File Submission
Oct-Nov 08
Nov-Dec 08
Dec- Jan 09
Jan – Feb 09
Feb–Mar 09
Mar- Apr 09
Apr-Jun 09
June-Aug 09
We are here:•Site Analysis of 63 sites completed 2nd Quarter
Aug- Sep 09 4th Quarter Provider
File Submission
Sep-Oct 08
CHCS DQ 1st Quarter Site Analysis Report
Update Continuity Book
CHCS DQ 2nd Quarter Site Analysis Report
Complete FY08 Performance Metrics
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Sample of Continuity Handbook
Data Element Description AF DQ Standards
National Provider Identifier (NPI)
10-Digit number for electronic billing
For any provider flagged as “Provider” these files require an NPI number. If services are rendered by a provider containing no NPI, it will prevent claims to be paid for patients with Third Party Insurance
Provider File Standards and Business Rules
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Sample of Workload Guidelines
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
704 - Dietician/ Nutritionist
B*** B*** Count Registered dieticians or licensed nutrition Professionals are responsible for providing medical nutrition therapy (MNT).
Yes Yes
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DQ Web Page
Contact:
Ms. Michele Gowen, RHIA, CCSAir Force Data Quality Program Manager
Tel (703) 681-6504 DSN 761Fax (703) 681-6011 DSN 761
https://kx.afms.mil/kxweb/dotmil/kj.do?functionalArea=DataQuality
Documents, briefings, policies/directives, training
and links
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Data Quality StatementCompleteness
Question 1. In the reporting month (include only B*** and FBN* accounts):
a) What percentage of clinics have complied with “End of Day” processing requirements, “Every clinic – Every day?” (B.5.(a))
Number of clinics with 100% EOD completed Total number of open clinic days for the month
BDQAS
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Data Quality StatementCompleteness Cont…
Question 1. In the reporting month (include only B*** and FBN* accounts):
b) What percentage of appointments were closed in meeting your “End of Day” processing requirements, “Every appointment – Every day?” (B.5.(b))
Number of closed appointmentsTotal appointments for the month
BDQAS
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Data Quality StatementTimeliness
Question 2. In accordance with legal and medical coding practices, have all of the following occurred:
a) What percentage of Outpatient Encounters, other than APVs, have been coded within 3 business days of the encounter?
BDQAS b) What percentage of APVs have been coded within 15 days of
the encounter?
BDQAS c) What percentage of Inpatient records have been coded within
30 days after discharge?
Internal Process - CCE Report (Un-coded records report)
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Question 3. In accordance with TMA policy, “Implementation of EAS/MEPRS Data Validation and Reconciliation,” dated 21 Dec 99 and “MEPRS Early Warning and Control System,” dated 28 May 02, along with the most current Service-Level Guidance a) Was monthly MEPRS/EAS financial reconciliation
process completed, validated and approved prior to monthly MEPRS transmission?
MEPRS Manager and RMO Office b) Were the data load status, outlier/variance, WWR-EAS
IV, and allocations tabs in the current MEWACS document reviewed and explanations provided for flagged data anomalies?
MEPRS Manager
Data Quality StatementValidation and Reconciliation
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Data Quality Statement Compliance
Question 4. Compliance with TMA or Service-Level guidance for timely submission of data (C.3.).*
a) MEPRS/EAS (45 days)
MEPRS Manager/MEWACS b) SIDR/CHCS (5th Duty of Day of the month)
BDQAS c) WWR/CHCS (10th Calendar Day Following Month)
BDQAS d) SADR/ADM (Daily)
BDQAS
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Data Quality Statement Rounds Compliance (New)
One calendar day of the attending professional services during each audited hospitalization will be audited from the randomly selected sample. For one day hospitalizations, that calendar day
will be audited. For all other hospitalizations, the registration
number will determine which calendar day will be audited. Odd numbers will use the first dayEven numbers will use the second day
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Data Quality Statement Coding Accuracy Calculation
Use the following new formulas for Q5b-d (Internal Process), 6b-d (Audit Tool), 7b-c (Audit Tool):
ICD-9: Number of correct ICD-9 codes
Total number of ICD-9 codes
E&M: Number of correct E&M codes
Total number of E&M codes
CPT: Number of correct CPT codes
Total number of CPT codes
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Question 5. Outcome of monthly inpatient coding audit
a) Percentage of inpatient records whose assigned DRG codes were correct?
b) Inpatient Professional Services Rounds encounters E & M codes audited and deemed correct?
c) Inpatient Professional Services Rounds encounters ICD-9 codes audited and deemed correct?
d) Inpatient Professional Services Rounds encounters CPT codes audited and deemed correct?
Data Quality Statement Compliance
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Question 5. Inpatient Records. CONT… e) What percentage of completed and current (signed
within the past 12 months) DD Forms 2569 (TPC Insurance Info) are available for audit? (How the patient answered is only relevant to answering “Question 6f”)
The DD Forms 2569 need to be available and current at the time of the audit to be in compliance with the UBO program.
Options for filing DD Form 2569: Maintain hardcopy DD Form 2569 in medical record Scan DD Form 2569 and store electronically Hardcopy DD Form 2569 stored in the MTF RMO/Business/TPC
Office
Data Quality Statement Availability/Accuracy
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Question 5. Inpatient Records. CONT…
f) What percentage of available, current and complete DD Forms 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?
Internal Process based on Question 6e. Does not apply to OCONUS bases.
Data Quality Statement Availability/Accuracy
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Question 6. Outpatient Records a) Is the documentation of the encounter selected to be
audited available? Documentation includes documentation in the medical record, loose (hard copy) documentation or an electronic record of the encounter in AHLTA. (Denominator equals sample size.)
b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.)
c) What is the percentage of ICD-9 codes deemed correct? d) What is the percentage of CPT codes deemed correct?
(CPT code must comply with current DoD guidance.)
a, b, c, d-Audit Tool Generated
Data Quality Statement Availability/Accuracy
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Question 6. Outpatient Records. CONT…
e) What percentage of completed and current (signed within the past 12 months) DD Forms 2569s (TPC Insurance Info) are available for audit?
Audit Tool Generated/Internal Process (This metric only measures whether or not a DD Form 2569 was collected/current in the record at the time of the encounter).
The DD Forms 2569 need to be available and current at the time of the audit to be in compliance with the UBO program.
f) What percentage of available, current and complete DD Forms 2569s are verified to be correct in the Patient Insurance Information (PII) module in CHCS?
Internal Process based on Question 6e. Does not apply to OCONUS bases.
Data Quality Statement Availability/Accuracy
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Question 7. Ambulatory Procedure Visits (C.7.a,b,c,d,e)
Questions 7.a,b,c,d,e Are the same as Questions 6.a,c,d,e,f
Data Quality Statement Availability/Accuracy
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Question 8. Comparison of reported workload data.
a) # SADR Encounters (count + non-count) / # WWR visitsBDQAS
b) # SIDR Dispositions / # WWR DispositionsBDQAS
c) # EAS Visits / # WWR Visits BDQAS
d) # EAS Dispositions / # WWR DispositionsBDQAS
e) # of Inpatient Professional Services Rounds SADR encounters (FCC=A***)/#Sum WWR (Total Bed Days + Total Dispositions) Note: FY09 Goal 80% (Will be graded red and green only)
Internal Process (Monthly Statistical Report)
Data Quality Statement Completeness
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Question 9. System Design, Development, Operations, and Education/Training (E.4.a).
a. # of AHLTA SADR encounters / # of Total SADR encounters
Note: ALL SADR encounters including APV and ER
BDQAS
Note: This question is to gauge the penetration of AHLTA at our MTFs. It is understood that not all clinical modules are deployed in the current version of AHLTA.
Data Quality Statement AHLTA Penetration
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Question 10. CHCS software used during the reporting month to identify duplicate patient registration records. (C.2a) a) What was the number of potential duplicate records in the reporting month?
Internal Process
Run the CHCS standard report – “Potential Duplicate Patient Search”. (For current advice about how to identify duplicate
records, please see TRICARE Data Quality Web page: http://www.tricare.osd.mil/ocfo/mcfs/dqmcp/refs_regs.cfm
Data Quality Statement AHLTA Penetration
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Question 11. I am aware of data quality issues identified by the completed Commander’s Statement and Review List and when needed, have incorporated monitoring mechanisms and have taken corrective actions to improve the data from my facility. (Electronic Signature Authorized)
Data Quality Statement Awareness
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Take Away
DQ is not just the DQ statement.
Data needs to be accurate, complete and timely.
Front-end processes are CRITICAL to back-end success
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Important References
DODI 6015.1-M, DOD Glossary DODI 6010.13M, MEPRS Program for Fixed MTFs and DTFs DODI 6010.15M, Uniform Business Office DODI 6040.40, Data Quality Program DODI 6040.41, Medical Records Retention and Coding at MTF DODI, 6040.42, Medical Encounter and Coding at MTF DODI, 6040.43, Custody and Control of Medical Records AFI 41-102, AF MEPRS Program for Fixed MTFs and DTFs AFI 41-120, Resource Management Operations AFI 41-210, Patient Administration Functions DoD Professional Coding Guidelines AF Workload Standardization Guidelines EASIV Reference Guide
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Useful Web Sites
Data Quality - http://www.tricare.mil/ocfo/mcfs/dqmcp/management_control.cfm
BDQAS - https://bdqas.brooks.af.mil/index2.htm UBU - http://www.tricare.mil//ocfo/bea/ubu/index.cfm UBO -
http://www.tricare.mil/ocfo/mcfs/ubo/about.cfm MEPRS – http://meprs.info MEWACS - http://www.meprs.info/mol3/mol3.cfm DFAS - https://mypay.dfas.mil/mypay.aspx HIPAA -
http://tricare.osd.mil/ocfo/mcfs/ubo/hipaa.cfm SAIC - http://www.chcs-dm.com/
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QUESTIONS?