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TRICARE Management Activity (TMA) Data Quality Management Control (DQMC) Workgroup Meeting Minutes June 14, 2012 ROLL CALL (* via phone) Here Member Member name Here Alternate X DQMC Chair [Name redacted] Army-DQ Manager [Name redacted] * [Name redacted] * Navy-DQ Manager [Name redacted] X AF-DQ Manager [Name redacted] * JTF CapMed [Name redacted] [Name redacted] [Name redacted] Non-Voting Member X TMA-DQMC Ctr [Name redacted] [Name redacted] Navy-DQ Ctr [Name redacted] [Name redacted] * AFMOA DQ Rep [Name redacted] * [Name redacted] TMA-UBO [Name redacted] X [Name redacted] X TMA-UBU [Name redacted] * TMA-MEPRS [Name redacted] TMA-DHCAPE [Name redacted] X HA PM Human Capital [Name redacted] Guests * TMA DQ Course Ctr [Name redacted] TMA-UBO Ctr [Name redacted] * [Name redacted] * TMA-MEPRS Ctr [Name redacted] * [Name redacted] * TMA Coding Audit Ctr [Name redacted] Army MEPRS [Name redacted] * [Name redacted] * Navy Coding Support [Name redacted] [Name redacted] AF Coding Support [Name redacted] * [Name redacted] AF MEPRS [Name redacted] [Name redacted] Invited Speakers * DHCAPE, Ctr [Name redacted] * DHSS, Ctr [Name redacted] The meeting was called to order at 2:03 PM in the DHHQ 3M157 Conference Room. The TMA-DQMC Contractor asked for permission to tape the meeting for the purpose of documenting the minutes and no one objected. The roll was called. The DQMC Chairperson welcomed attendees and thanked them for their participation. 1  Introduction The DQMC Chairperson welcomed the group.  MTF Coding Audit FY 2011 and FY 2012 The TMA Coding Audit Contractor reported submission rates from the Services: The Army was 96%, Navy 98%, and Air Force 96%. Of these records they have reviewed 84% of Army records, 68% of Navy records, and 79% of Air Force records. They anticipate being finished tomorrow, when the auditors will start on Monday. Tomorrow, she will send an update of records received. Action Item #1: The TMA Coding Audit Contractor to send a list of missing records to the Service representatives. The DQMC Chairperson noted that the new contract may be extended for another six months to include the analysis of the results beginning in September. He noted that the group has done a great job.  Review Action Items Handout: Summary of Action Items from May meeting May 2012 – Item #1: The TMA-DQMC Contractor to send the TMA-UBU Representative a list of people who are interested in the status of the BOXI issues. CLOSED. The product is stabilized. May 2012 – Item #2: The Navy-DQ Manager to send the TMA-UBU Representative an e-mail about the Trouble Ticket related to M2 data displays. CLOSED. The TMA-UBU Representative still needs to look into the issue. The DHCAPE Contractor offered to help if she can see the Trouble Ticket. May 2012 – Item #3: The TMA-DQMC Contractor to send out the DQ class roster. CLOSED. The DQMC Chairperson noted about the next DQ course in September. The TMA-DQMC Contractor reported that the Friday M2 Hands-On will be held at DHHQ, but the regular course will be held at the Mark Center. In the future, The DQMC Chairperson would like to be held in the DHHQ fourth floor conference center. His concern is getting them on the DHHQ campus. Action Item #2: The TMA-UBU Representative to share the Navy-DQ Manager’s e- mail on the M2 data displays with the DHCAPE Contractor, and others.  TMA Summary DQ Metrics Handouts: TMA Summary March Data FY 2012 2 The TMA-DQMC Contractor noted that the Services have answered their questions. The Air Force has answered 5d. She noted that the JTF 2c, SIDR Coding Timeliness, is the result of a lack of coders. The JTF CapMed Representative reported this is being addressed at Fort Belvoir. She does not believe it will continue to be a problem. The TMA-DQMC Contractor noted the questions related to the 9s. The JTF CapMed Representative noted that the comments for 9b, 9e are above the usual place. The TMA-DQMC Contractor noted that 9b is not a MEPRS issue. The JTF CapMed Representative says this is a Walter Reed problem only. SIDRs are not being documented and closed. The TMA-DQMC Contractor noted that Rounds are still an issue. The JTF CapMed Representative responded that they will be done with April processing for both sites tomorrow for EAS. They are catching up. In relation to Navy 2c, the Navy-DQ Manager noted the issues are addressed in comments section. MTF has been contacted; they have not recovered from the backlog with the ICD-9 tables due to staffing issues. The DQMC Chairperson mentioned an issue that he is concerned about – Coding Timeliness. The driver behind the timelines for DQ coding metric reporting is the Accounts Receivable Policy from the Director, Financial Plans and Policy, several years ago (Defense Health Program Accounts Receivable Policy; May 2, 2008). It said Outpatient encounters would be aged on the 15th day after the encounter, and Inpatient records would be aged on the 31st day after the termination of the encounter. The DQMC Chairperson needs to talk to the Finance people about how these timelines may degrade the quality of coding, especially the APVs. While these timelines may seem long in the civilian world, The DQMC Chairperson notes that accuracy is most important. The TMA-UBU Representative mentioned that the UBU community will be shortening up the coding timeliness [in DoDD 6040.41]. The TMA-DQMC Contractor brought up the Hard Spots issue for the 2012 DoDI questions and trying to move off the WWR benchmark for all SIDR disposition comparisons. The DQMC Chairperson talked about the sense that WWR is antiquated and no longer essential for doing a comparison. He asked what else might be appropriate for a comparison, such as CHCS. He also asked the impact on MEPRS. The TMA-UBU Representative said the timing within the SIDR should be sufficient. The DHCAPE Contractor, who wrote the process, suggested the process can be updated easily. Bed days are a problem when coding for completeness. (The TMA-DQMC Contractor reviewed the purpose of the different sets of questions: 2 is for compliance, 4 is for timeliness, and 9 is for counts of open versus closed.) Dr. Toney is not interested in inferred records. The TMA-UBU Representative and the DHCAPE Contractor will discuss the inferred records issues offline. The Navy-DQ Manager said they were going to start processing twice a month. The DHSS Contractor reported the WWR is not being turned off, although the DHCAPE Contractor noted that that has been proposed. Notwithstanding, The TMA-DQMC Contractor noted that the DQMC workgroup’s perspective is that they would no longer mandate the WWR be run. The Alternate Representative of AFMOA DQ asked if this change could be done by the new fiscal year. The TMA-UBU Representative and the DHCAPE Contractor thought not. The DQMC Chairperson suggests not using it and letting others decide whether or not they need it. 3 The TMA-DQMC Contractor had one more item for the CCE Billable report. The Navy-DQ Manager said the Billable Summary Report requested is going to be ready with the 1 October release. She wanted to know if there is any delay anticipated because of the ICD-9 table update. The TMA-UBU Representative says only one change is known for ICD-9 changes. He said conversations on ICD-9-CM are to start next month, so those changes are not known. The TMA- UBU Representative said the primary thing that delays CCE for the grouper in the MHS world is the implementation of the TRICARE-specific MS-DRGs.  Service Issues Army: The Army had no issues at this time. Navy: The Navy-DQ Manager has no issues at this time. Air Force: The Air Force-DQ Manager had no issues at this time. JTF CapMed: The JTF CapMed Representative requested help with their two MTFs. The Navy-DQ Manager explained that the Services cannot do true root-cause analysis; they are all developing plans of action and management. The MTFs are sticking to standard responses and are not giving useful answers. The JTF CapMed Representative wants the group to know they are struggling to get up with their processing.  MHS Service Desk T3 Trends Handout: May MHS Service Desk IT Report The TMA-DQMC Contractor reported no critical trends.  DQ Course Update Handouts: None The TMA-DQMC Contractor reported they have started September registration: Army has 11 for 17 slots, Navy 8 for 10, AF 9 for 14, JTF 1 for 3, and TMA TRO has 5 for 2 (3 over; on wait list). The DQMC Chairperson is interested in how registration goes due to cutbacks in budgets.  DMHRSi Update 4 Handouts: None The HA PM Human Capital Representative reported that they have completed a review of the customizations. Twenty-eight items considered costly to maintain. They would like to keep 6 and delete 22. They would like to eliminate the way GME and GDE students submit their timecards. They would like to eliminate the calculation done to check the type (clinical and training) and number of hours entered by residents. This change was approved for the new release. It will be effective in June or July 2014. The managers of the Residents do a lot of checking to see if the hours are in the right categories. The FMA-UBU Representative would like to see if this change affects the data calls he reports to Lockheed because it affects the ASA rates. The HA PM Human Capital Representative also mentioned that the Services’ DMHRSi representatives are going to an Oracle users’ group meeting, and he would welcome questions to pose to Oracle.  MEPRS Handouts: May MEWACS Hits Comparison, May MEWACS Portal Hits, EAS IV Repository Completion Compliance Tables Handouts: None The TMA-MEPRS Representative introduced the MEPRS Completion and Compliance Dashboard, which was designed to simplify completion and compliance reporting. It is a mirror of the Services’ reporting and it has four components: (1) Compliance Rate (“data in on time”) – A monthly comparison relative to 45-day submission date. (2) Completion – Heretofore it only compared the total months of data against expected months; now it reflects the total expenses versus the total expenses expected. (3) Number of Outliers – How many have been worked for completion? (4) System Availability Comments are welcome by e-mail.  UBO Update Handouts: None. The TMA-UBO Representative reported the OIB rates and the Cosmetic Surgery Estimator (CSE) will be available in July. Webinars are being done on those topics this month now. The CG billing reimbursements for PPS are in process; the Army and JTF CapMed are paid; the Navy payment is in process because the BUMED is deciding whether the payments are to be made to BUMED or the MTFs; and the Air Force is not participating this year. 5 The Navy has received a waiver for Naples for the DD-Form 2569 that is good until the end of 2013.  UBU Update Handouts: None. The TMA-UBU Representative announced the UBU has published an update to Outpatient Guidelines since the last DQMC meeting. Their next major UBU meeting will be in July. The TMA-UBU Representative asked about the DES and DEA PATCAT list from UBO. Action Item #3: The TMA-UBO Representative’s Alternate to send the TMA-UBU Representative the new UBO PATCAT list.  Wrap-Up and Next Meeting The DQMC Chairperson noted that the Next Hard Spots meetings are to be held June 26 and July 9. The meeting adjourned at 3:29 PM. The next meeting is scheduled for July 19, 2012, from 2 – 3:30 PM. The location and dial-in number are to be announced. Read-aheads are due Monday, June 11, 2012, COB. Summary of Action Items June 2012 – Item #1: The TMA Coding Audit Contractor to send a list of missing records to the Service representatives. June 2012 – Item #2: The TMA-UBU Representative to share the Navy-DQ Manager’s e-mail on the M2 data displays with the DHCAPE Representative and others. June 2012 – Item #3: The TMA-UBO Representative’s Alternate to send the TMA-UBU Representative the updated PATCAT list. 6
"DQMC June 2012 - Final_Redacted"