Atch 7 AFMSA Coding Audit Methodology.pdf

AIR FORCE MEDICAL SERVICE (AFMS)

INTERNAL CODING AUDIT

METHODOLOGY – AMBULATORY

12 August 2005

Version 3

APPENDIX E

to “Air Force Compliance Plan for Coding and Billing”

TABLE OF CONTENTS

OVERVIEW

Summary of Changes

SECTION 1 - INTRODUCTION

Accuracy System Requirements Health Information Privacy Accountability Act (HIPAA)

SECTION 2 - BACKGROUND

* For Outpatient Records - C.6

* For Ambulatory Procedure Visits (APV)

SECTION 3 - METHODOLOGY

Auditor Qualifications Audit Process Audit Sample Design Audit Purpose

SECTION 4 - POINTS OF CONTACTS

AFMSA

Medical Resource Management Patient Administration Division

APPENDIX A – DOWNLOADING FILES

Initial Setup Downloading Files

APPENDIX B – CODING AUDIT TOOL

Import Data Record Pull Lists Audit Status Report Reports Toolbar Coding Audit Entry Printable Audit Audit Results Reports Export Full Audit for PHSD Export Audit by MEPRS Export All Results

APPENDIX C – EXPORTING AUDIT FILES

Export Completed Audit Upload of Completed Audit

APPENDIX D – AUDIT SAMPLE SIZE REQUIREMENTS

AFMSA INTERNAL CODING METHODOLOGY OVERVIEW

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OVERVIEW

This overview describes the procedures and tools to be used by Air Force coding auditors in support of the AFMS Coding Compliance plan and the Internal Coding Audit Methodology. A principal goal of this effort is to provide the AFMS at MTF through headquarters level with a precise and standardized estimate of the level of coding accuracy.

The Population Health Support Division (PHSD), a division of the Air Force Medical Support Agency (AFMSA), provided the MTFs with a detailed electronic data entry tool. The tool created a more efficient method for data collection shortening the time for auditing each encounter. A redesign of the sampling methodology reduced the number of encounters required for auditing and allowing more time for other activities by the auditors.

The data collection tool allows for reports of the audit results from the provider level on

up. The results include the DQM metrics, comparing the electronic SADR data to the chart reviews and comments by the auditors to aid in the development of education and training plans. Any additional analyses not presented in these reports can easily be created from the data the tool by exporting into MS Excel®.

Summary of Changes Since the initial version of the Internal Coding Audit Methodology was released in January 05, we have communicated with every MAJCOM concerning the procedures for auditing. Based on the feedback, numerous changes were made to the audit instructions, as well as the audit tool. The following information reflects those changes, which are also detailed throughout this guide:

• The methodology switched to a stratified random sample based on the volume of encounters at each facility, so the volume of workload to audit is decreased from the previous sample design.

• Clarification that someone with commensurate experience to ensure accurate and correct coding has been accomplished may do the audit – must have MAJCOM coordination

• The completed audits are due to the Population Health Support Division (PHSD) no later than the 20th day of each month via the PHSD secured website (see Appendix C for details). If the 20th day falls on a weekend or holiday, the completed audits must be uploaded the next business day. MTF personnel must communicate with the MAJCOM and PHSD if audits are going to be late.

• This tool is a temporary measure until the implementation of a web-based Coding Audit Review System (CARS).

AFMSA INTERNAL CODING METHODOLOGY SECTION 1 - INTRODUCTION

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SECTION 1 - INTRODUCTION

This document outlines procedures necessary to implement a standard methodology for comparing each completed Standard Ambulatory Data Record (SADR) with documentation of the encounter. The methodology will be reviewed on an annual basis and adjusted accordingly. This guidance enables an auditor to:

• Establish uniform and consistent reporting mechanisms for internal and external coding accuracy audits.

• Quantify coding agreements between medical record documentation and the

SADR.

• Quantify the extent of over and under coding (once electronic support system implemented).

• Provide MTF Commanders and executive leadership with a summary of findings and recommendations for improving the accuracy of healthcare record coding.

• Identify areas of weakness to use as the basis for data quality improvement and focused education.

• Permit centralized analyses of coding accuracy and trend identification.

• Determine the outpatient encounter documentation availability for audit.

Accuracy Accuracy will be determined using the current Department of Defense (DoD) and Air Force coding guidelines. Assessment of the correctness of Evaluation and Management (E&M) codes will be determined in accordance with 1997 Centers for Medicare and Medicaid Services (CMS) E&M Guidelines. The 1997 guidelines will be the standard for the AFMS.

The methodology provides a statistical precision of +/- 3% for estimates of the metrics, and is in line with AFMS and DoD directives. To assist auditors, the staff at the Population Health Support Division has created an easy to use data collection tool (Appendix B) that essentially provides all reporting information of the audit performed.

Further the data satisfies reports to higher headquarters from each MTF within the Air Force.

System Requirements Minimum systems requirements include: MS Access, Windows 2000 or greater, access to network shared drives (drive to be designated by local management).

Health Information Privacy Accountability Act (HIPAA) Note that all information has been processed in such a way to meet HIPAA and Privacy Act requirements. All data is transferred via secure website to designated personnel at

AFMSA INTERNAL CODING METHODOLOGY SECTION 2 - BACKGROUND

12 August 2005 Page 3 each MTF within the AFMS. The information and reports are Quality Assurance Documents under 10 USC 1102. Copies of information from this application will not be released under penalty of law. Any person who willfully discloses a medical quality assurance record other than as provided in this section (Reference: United States Code Annotated, Title 10 Armed Forces, Chapter 55 Section 1102), knowing that such record is a medical quality assurance record, shall be fined no more than $3,000 in the case of a first offense and not more than $20,000 in the case of a subsequent offense.

SECTION 2 - BACKGROUND

The audit of ambulatory medical records has two goals.

The First goal of the ambulatory medical records audit is to comply with DoD Directive (DoDD) 6040.41 “Medical Records Retention and Coding at Military Treatment Facilities” (section 4.3.4), which indicates 100% medical records accuracy in each coding area. The Air Force will achieve this goal through a 3 year plan denoted below:

• 95 percent in FY04

• 97 percent in FY05

• 100 percent in FY06

Coding classifications affected include:

• International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9- CM), diagnosis/factors influencing health/external causes of injury/morphology, and procedures

• Health Care Common Procedure Coding System (HCPCS)

• HCPCS Level 1: Current Procedural Terminology (CPT)

• Evaluation and Management (E&M)

• HCPCS Level II: HCPCS National Codes

The second goal of the ambulatory medical records audit is to provide information to problem areas of coding in order to facilitate targeted training of MTF personnel. This is accomplished through the report functions of the application by providing information on coding errors down the provider level. This second goal is a follow-up to DoDD 6040.40 “Military Health System Data Quality Management Control Procedures”, includes the following part of the “Data Quality Management Control Review List” - located in the MTF commanders monthly report:

* For Outpatient Records - C.6.

In a random review of CHCS outpatient encounters from the reporting month, the medical records staff determined the following percentage from a minimum sample of

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30 records and/or the sampling size as set by Service-Level guidance, whichever is greater: (Question 6(a) of Commander's Statement.) (See applicable DoDD/DoDI on Medical Records Retention and Coding and Service specific guidance.)

a) Percentage of outpatient medical records on-hand containing the documentation and/or the loose documentation of the encounter selected to be audited or documented as checked out? (Denominator equals sample size.)

Note Formula: Number of encounters available/Number of requested encounters.

Note: This question is asking “Is the documentation of the encounter available to be audited?” If the documentation is available however the patient’s outpatient health record is not available, the “record of the encounter” is available for audit.

b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.)

Note: If the paper record does not indicate an E&M code was required and the computerized record does not have an E&M, the record is deemed correct.

Note Formula: Number of Records with Correct E&M codes/Number of Records Audited requiring E&M Codes.

c) What is the percentage of ICD-9 codes deemed correct?

Note Formula: Number of Records with Correct ICD codes/Number of Records Audited.

d) What is the percentage of CPT codes deemed correct? (CPT code must comply with current DoD guidance.)

Note: If the paper record does not indicate a CPT was required and the computerized record does not have a CPT, the record is deemed correct.

Note Formula: Number of Records with Correct CPT codes/Number of Records

e) What is the percentage of current DD Form 2569s (TPC Insurance Info) maintained in the medical record (non-active duty only)? (See DoD 6010.15-M, MTF UBO Manual)

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* For Ambulatory Procedure Visits (APV)

* C.7. In a random review of CHCS Ambulatory Procedure Visits (APV) appointments from the reporting month, the medical records staff determined the following percentages from a minimum sample size of 30 "on-hand" records (extended/abbreviated) or maximum available if fewer than 30, (documentation of visit is included in record) and/or the sampling size as set by Service-Level guidance, whichever is greater: Question 7(b, c, d, e) of Commander's Statement.) (See applicable DoDD/DoDI on Medical Records Retention and Coding and Service specific guidance)

a) Percentage of outpatient medical records on-hand containing the documentation and/or the loose documentation of the encounter selected to be audited or documented as checked out? (Denominator equals sample size.)

b) What is the percentage of E & M codes deemed correct? (E & M code must comply with current DoD guidance.)

Note: If the paper record does not indicate an E&M code was required and the computerized record does not have an E&M, the record is deemed correct.

Note Formula: Number of Records with Correct E&M codes/Number of Records Audited requiring E&M codes.

c) What is the percentage of ICD-9 codes deemed correct?

Note Formula: Number of Records with Correct ICD codes/Number of Records

d) What is the percentage of CPT codes deemed correct? (CPT code must comply with current DoD guidance.)

Note: If the paper record does not indicate a CPT was required and the computerized record does not have a CPT, the record is deemed correct.

Note Formula: Number of Records with Correct CPT codes/Number of Records

e) What is the percentage of current DD Form 2569s (TPC Insurance Info) maintained in the medical record (non-active duty only)? (See DoD 6010.15-M, MTF UBO Manual)

Note Formula: Number of Current DD2569s/Number of Non-Active Duty outpatient medical records audited.

AFMSA INTERNAL CODING METHODOLOGY SECTION 3 - METHODOLOGY

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SECTION 3 - METHODOLOGY

Each Air Force MTF must formulate a process to examine healthcare records for coding accuracy based on these guidelines. MTFs may conduct additional studies to support improved coding.

Auditor Qualifications Audits should be performed by a coding professional. If a certified coder is not available, someone with commensurate experience can perform the audit to ensure accurate and correct coding has been accomplished. There must be MAJCOM coordination and approval if a non-certified coder is to perform the audit.

Coding certifications include the following:

• American Health Information Management Association (AHIMA) o Certified Coding Specialist (CCS) o Certified Coding Specialist-Physician Based (CCS-P)

• Accredited by the American Academy of Professional Coders (AAPC) o Certified Professional Coder (CPC) o Certified Professional Coder-Hospital (CPC-H)

Advanced qualifications for coding professionals as designated by AHIMA include:

• Registered Health Information Administrators (RHIAs)

• Registered Health Information Technicians (RHITs)

• Coders will undergo annual peer review. Coders will not review their own records.

Audit Process A random audit sample list will be provided via an audit file located on the PHSD web server (see Appendix A for directions). The list will be of select patients who are enrolled to the MTF.

Completed audits are due to the Population Health Support Division (PHSD) no later than the 20th day of each month via the PHSD secured website (see Appendix C for details). If the 20th day falls on a weekend or holiday, the completed audits must be uploaded the next business day. MTF personnel must communicate with the MAJCOM and PHSD if audits are going to be late.

New list samples will be provided on the 21st day of each month and are accessible through PHSD website. If the day falls on a weekend or holiday, the pull list will be uploaded the next business day after the prior completed audits are due.

AFMSA INTERNAL CODING METHODOLOGY SECTION 3 - METHODOLOGY

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Audit Sample Design The methodology is a stratified random sample. Stratified random sampling is common in auditing, it allows for the sample to pull encounters from across the MTF. The strata used encounter type which is defined as Primary Care, APV and Specialty Care.

Proportional allocation is used so results for the encounters audited will not have to be adjusted later. The proportions were calculated using the monthly average for the number of encounters occurring in each stratum for each individual MTF for Fiscal Year 2004. This will be reviewed on a six-month cycle. The final audit results are seen at the MTF at the end of the month. This method also allows a precise estimate of metrics for the MTF. The DQM and the P2R2 metrics will be precise to plus/minus 3% for each MTF per month. The DQM and P2R2 metrics will differ due to putting three months data together for reporting to the P2R2 to allow more precise estimates down to the MEPR3 level.

The minimum number of encounters required per MTF for audit and the number of encounters provided in the pull list preloaded in the audit tool are presented in Appendix E. The number of encounters in the pull list is three times the number required to allow for encounters unavailable for audit as well as additional auditing by the MTFs and MAJCOMs if desired. Additional auditing should be done the same across for each MEPR to maintain the proportional nature of the sample design. If targeted additional audits are desired, a copy of the tool should be made for the additional audits and kept separate from the reported audits for calculation. These calculations use a confidence level of 95%. The population of encounters was estimated for each MTF as a monthly average for Fiscal Year 2004. What this translates into is, if the MTF estimate is 50% correct coding for E&M codes, the true population value for the MTF will be between 48.5%, and 51.5% and if the estimate is 90% the true value will be between 87.3% and 92.7% for 95% of the samples drawn.

Audit Purpose With the audit tool design, information for education and training can be compiled, and with third level MEPRS code and provider level reports. Based on the reports, the types of errors that are occurring can be identified and training can be conducted.

If the number of encounters for a clinic is less than the sample size, all available encounters need to be audited. Every attempt needs to be made to meet the requirement outlined in this guidance.

All facilities will provide monthly audit figures to their Data Quality Managers to support the Data Quality Checklist, as part of the Data Quality Management Control Program (DQMC). The audit for the AFMSA/SGOZ will suffice for both requirements.

The DoD Commanders’ Data Quality Statement will reflect the audit results using the audit process prescribed in this document.

AFMSA INTERNAL CODING METHODOLOGY SECTION 4 - POINTS OF CONTACTS

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A data collection tool (Appendix B) is provided to reduce input errors. It must be used.

The individual level data sent back to PHSD for aggregation and analysis prior to being reported beyond the MTF level. The data collection tool is a Microsoft Access database with an easy to use front-end application for data entry. The data collected will be sent back to PHSD for analysis allowing for consistent methodologies in the calculation of the metrics. The results of audit are automatically available from the tool. This tool is a temporary measure until the implementation of a web-based Coding Audit Review System (CARS).

The following metrics are calculated by the provided tool for APV and non-APV encounters, and satisfy the requirements of the DoD Commanders Data Quality Statement.

• Availability of encounter documentation

• Percentage of encounters with correct E&M codes

• Percentage of encounters with correct ICD-9 codes

• Percentage of encounters with correct CPT/HCPCS codes

• Percentage of non-AD records containing DD Form 2569, Other Health Insurance

SECTION 4 - POINTS OF CONTACTS

AFMSA

Coding, audit methodology, statistical explanations, and audit tool information PHSD Help Desk: 1-800-298-0230

Medical Resource Management AFMS Data Quality Manager – MSgt JoAnn Milster, DSN 761-6504 AFMS MEPRS Manager – TSgt Jody Callender, DSN 761-6356

Patient Administration Division TOPA – MSgt Jeff Kolesar, DSN 297-4699

AFMSA INTERNAL CODING METHODOLOGY APPENDIX A – DOWNLOADING FILES

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APPENDIX A – DOWNLOADING FILES

The PHSD website is used to download the coding audit tool and data files from the server. This site is also used to upload the completed coding audit files.

Initial Setup These instructions should be followed the first time a user accesses the site.

1. Open the https://phsd.brooks.af.mil website. Make sure that the address reads https.

The PHSD Sign On page will be displayed.

2. Enter the username and initial password and click the button to continue.

The change password screen will be

3. Enter a new password.

The new password must contain 1 uppercase letter, 1 lowercase letter and 1 number. It must have a minimum of 8 characters. The password will expire every 90 days.

4. Reenter new password to confirm.

5. Click the

The Upload/Download Wizard page will be displayed.

https://phsd.brooks.af.mil/

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This Wizard will allow the user to download files from PHSD as well as upload their completed audits.

6. Click the link to continue.

A Security Warning window will be

7. Click the button to continue.

Note: Depending on the user’s Internet browser version, the window may look different than the one pictured above. If the options are Yes and No, click the Yes button.

A pop-up window will be displayed letting the user know that the installations has completed successfully.

8. Click the button to

The PHSD Home page will be

Note: If the wizard cannot be installed, the user will still be able to download and upload files. The screens will just be slightly different.

Downloading Files The user will receive an e-mail notification when the Coding Audit tool or a new data file for an audit is uploaded from PHSD.

1. Click on the link in the e-mail.

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The PHSD File Farm page will be

The name of the file to be downloaded is displayed near the top of the page.

2. Click the link located under the File Actions heading to continue.

The File Download window will be

3. Click the button to select a folder.

Note: If the wizard was not installed properly, a security window will be displayed. Click the button.

The select the destination filename window will be displayed.

4. Create a new folder named Coding.

5. Once in the Coding folder, click the button.

The MOVEit Download wizard window will be displayed letting the user know the file was downloaded successfully.

Note: If the wizard was not installed properly, the download complete window will look slightly different than the one shown below.

6. Click the button.

Windows explorer will open displaying the file.

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7. Right-click on the file.

A drop-down menu will be displayed.

8. Select the Desktop (create shortcut) option listed under the Send To option.

A Microsoft Access shortcut icon with the name of the downloaded file will be displayed on your desktop.

The user will also receive a notification e-mail when the data of the records and encounters for the actual audit is sent.

The DMIS code for that site will be part of the file name. This file will have a .csv extension. Each month’s pull list will also have the date in the file name.

Follow the same steps for downloading the pull list as followed for the Coding Audit Tool.

It is important to note that new files are automatically deleted after 30 days. The user should not wait longer than 30 days after receiving the notification e-mail to download files.

Pull lists will be available on the 21st of each month. If a new version of the tool is being released for use that month, it will be sent prior to the pull list being sent.

Other types of documentation and FAQs will be distributed via this website.

AFMSA INTERNAL CODING METHODOLOGY APPENDIX B – CODING AUDIT TOOL

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APPENDIX B – CODING AUDIT TOOL

1. Double-click on the Coding Audit

Tool shortcut, , created after downloading the tool..

Depending on the user’s security settings, a Security Warning window may be displayed.

2. Click the button to

The main menu will be displayed listing the various functions for the audit, from importing the pull list, collecting the data to producing reports. The current version of the tool is listed in the blue box on the menu. Ensure that the correct version is being used by comparing it with the current FAQ.

Import Data

1. From the main menu, click the button to import the pull list data into the tool.

The Data Downloaded? window will be displayed.

2. Click the button to continue.

Note: If the file has not been downloaded, see Appendix A for instructions on downloading files.

3. Navigate to the folder where the file was saved.

4. Select the file. Naming structure is codingaudit_DMIS_MMDDYYYY.csv

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Importing data will overwrite any data in the tool. Be sure all past audits have been exported and a copy of the export file has been saved for backup purposes.

A pop-up window will be displayed notifying the user that the data was imported successfully.

5. Click the button to return to the main menu.

Record Pull Lists

6. From the main menu, click on the

The Select Audit Type window will be

Note: The inpatient buttons are currently inactive.

7. Click on the button next to the required audit type.

A list of records and encounters to audit will be displayed.

The list contains the Sponsor SSN, FMP, and Name, EM code, Encounter Date and the Audit Order number.

If the record was not available, there is a place to annotate the reason record not found so the information can be entered into the coding audit entry screen for that encounter audit.

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Audit Status Report

1. From the main menu, click on the

The Audit Status and Totals window

The audit status report provides an overview of the number of audits to be done for each MEPRS. It gives a snapshot view of the total numbers of audits, audits completed, and number in each MEPRS pull list.

The report also totals the numbers by Audit Type and overall. It can be used to know where to divide the workload between auditors as well as to see progress on the audits being done.

Reports Toolbar When a report is opened, a toolbar will also be displayed near the top of the Access window.

1a. Click the button to print directly from Access.

1b. Click the button to export the list to Excel.

1c. Click the button to export the list to Word.

Coding Audit Entry

1. From the main menu, click on the

Note: The inpatient buttons are currently inactive.

2. Click on the button next to the

A Select Audit Type MEPR Audit pop-up window will be displayed.

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3. Click on the drop-down menu and select the type of encounters to audit (Primary Care, APV or Specialty Care)

The selected option will be displayed in the drop-down field.

4. After selecting an option, click the

The first encounter audit in that MEPRS will be displayed in the Data Entry Form.

The entry form is preloaded with information from the SADR. It includes only data available through a central database and not all the data available at the local MTF.

The data at the top of the window with blue field labels is preloaded and cannot be modified.

The top of this form also includes count information. It lists the MEPR3 and MEPR4 for this encounter. It also lists the audit order number of the number of records in this MEPRS pull list.

The other count data updates as audits are completed. This data includes the Audits Complete, Total To Audit and the Remaining Audits for that MEPRS code.

The auditor will enter the information in the fields with yellow labels.

The first set of editable fields is the E&M validation.

5. Type in auditor’s name in the Auditor field.

After the auditor’s name is entered the first time, it will be available from the drop-down menu.

The visit data is preloaded along with the E&M code in the SADR and the Appointment ID number.

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6. Enter the code into the Auditor Enter

EM Code: field.

7. If the code entered does not match the

SADR E&M, select a reason from EM Variance drop-down menu.

Only one E&M code is currently available in the central data and is the only one being audited.

8. Enter the modifier in the Modifier

Currently the modifier is not available in the central database, but this field has been provided for the auditor to use. The modifier field is not mandatory and is not used in the audit metrics.

9. Enter any comments on the E&M section of the audit into the Auditor Comments field.

10. Check all the appropriate boxes necessary to complete the audit and calculate the metrics.

If unsure of what box to check, click the button.

A chart explaining the scenarios of the checkboxes will be displayed.

There is also a check box for the availability of the 2569 for non-active duty.

11. If the 2569 is present in the file, enter the date of the form in the 2569 Date

12. Mark the Record Ordered checkbox.

If the record or encounter is not available for any reason, even if checked out, these check boxes must be complete. If the record is checked out, this must be complete as checked out records do not count in the record availability metric.

13. Click the button to see a listing of the various definitions of the E&M codes by type.

The second set of editable fields is for ICD-9 validation.

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14. Enter the code to validate the ICD-9 diagnosis.

The field next the code will display a Yes in black font if the code matches the one in the SADR or a No in red font if the code is different.

15. If the code entered does not match the

SADR, select a reason from the drop-down list.

16. Enter any problems not addressed in the drop-down menu in the Auditor

Sequencing: The primary diagnosis code must be correct. The second through fourth codes do not need to be audited for sequencing, but for accuracy of the codes themselves.

17. Click the button to view a list of diagnosis codes available.

The third set of editable fields is for CPT/HCPCS validation

18. Enter the codes to validate in the Auditor Enter CPT/HCPCS code:

fields.

The field next the code will display a Yes in black font if the code matches the one in the SADR or a No in red font if the code is different.

CPT/HCPCS has an additional field to add units. This is not a mandatory field, nor is this field audited.

19. If the code entered does not match, select a reason from the drop-down

20. Enter any problems not addressed in the drop-down menu in the Auditor

21. Click the button to view a list of CPT/HCPCS codes available.

22. Enter any comments on the overall encounter audit in the General Comments on this Encounter Audit field at the bottom of the window. .

23. Check the Audit Complete checkbox when the audit has been completed with all codes validated from the encounter documentation.

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24. To move to the next record for audit, click the button.

An error message will be displayed if some of the check boxes have not been marked.

In order to proceed to the next encounter audit, the current audit must be marked Audit Complete OR Record Not Available OR Encounter Not Available.

25. To print the current encounter audit, click the button at the bottom of the audit window.

26. It the audit is complete, click the

An error message will be displayed if the audit is marked as completed but no code was entered to validate the E&M.

A different error message will be displayed if Encounter Not Available AND Audit Complete were marked.

Since encounter documentation is needed to complete an audit, both check marks for those boxes cannot be completed.

Printable Audit If an audit needs to be done off site or needs to have the data collected manually, it is possible to print out the audit entry form for data collection and later entry into the computer.

The selection of the audit to print is similar to the coding audit entry.

1. From the main menu, click the button.

The Select MEPR for audit type

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3. Select the MEPRS clinic service to be audited from the next drop-down menu.

4. Click the button.

The printable audit will be displayed.

5. Click the button on the toolbar at the top of the window to print all records in that MEPR.

Audit Results Reports Reports on the audit results can be generated at any time after data entry begins. The estimates are not accurate until the required sample size numbers are reached.

1. From the main menu, the button

A pop-up window will be displayed listing all the available audit status reports.

required audit status report.

The report will be displayed.

DQM Metrics Commanders Report The DQM metrics reports give the results by all APV and non-APV encounters at a MTF level.

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Overall Metrics The overall metrics is the results for the MTF using all audits.

Audit Type Metrics The audit type metrics give results for primary care, specialty care, and APV encounters.

MEPRS Metrics The MEPRS metrics report gives results for each MEPRS level audited.

Provider Metrics The Provider metrics report gives results based on the provider that appears in the electronic SADR record.

Top Coding Errors Overall The top coding errors reports generate a list of the discrepancies chosen from the drop-down list as well as free text entered to identify the most frequent types of errors.

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Top Coding Errors by MEPRS The top coding errors report is also available by MEPRS.

Top Coding Errors by Provider The top coding errors report is also available by Provider.

Comments Summary The comments summary report pulls any comment listed on an encounter audit into one report. The report is sorted by audit type, MEPRS, and audit order.

DD2569 Not Available List The DD2569 Not Available list provides documentation by Audit type and MEPRS of the records in the audit without the DD2569 form.

DD2569 Date List The DD2569 Date list provides documentation by Audit Type and MEPRS of the dates on the forms found in the audited records. It is sorted within the MEPRS by oldest to newest.

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Auditor Records Opened Report The Audit Records Opened Report provides the number of records opened by an auditor regardless of whether the audit was completed or not.

Export Full Audit for PHSD

1. After the audit is complete for all

MEPRS, click the

The Browse for Folder window will be

2. Locate the folder where the audit will be saved.

3. Click the button.

A confirmation window will be

The name of the full export will be as follows:

“CompletedCodingAudit_

DMIS_YYYYMM_ OUT_

YYYYMMDD.csv”

This file needs to be kept at the MTF also for backup purposes as it is the RAW data file of all information from that month’s audit.

Export Audit by MEPRS Raw audit data information can also be exported by MEPRS.

1. From the main menu, click the button.

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The Select MEPR for audit type

3. Select the MEPR from the list.

5. Locate the folder where the audit will

7. Click the button.

The name of the file will be in the following structure:

“CompletedCodingAudit_

DMIS_MEPRS_MMDDYYYY_

AuditType.csv”

PC = Primary Care SC = SpecialtyCare

APV = APV

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Export All Results All audit results should also be exported for backup and reporting purposes.

1. Once audits are completed, click the button or the

2. Locate the folder where the audit will

3. Click the button.

This process will take longer than the other export options. Once completed, a confirmation window

All results will be exported as individual files. They will be named as follows: “ReportName_DMIS_ MMDDYYYY.csv” for the snapshot files and “ReportName_DMIS_ MMDDYYYY.xls” for the Excel files.

These reports should be kept at the MTF level. They do not need to be uploaded to the PHSD server for processing. The MAJCOM may request that certain reports be forwarded to them each month from this list. Please confirm with the

MAJCOM.

These reports will show progress over time.

AFMSA INTERNAL CODING METHODOLOGY APPENDIX C – EXPORTING AUDIT FILES

12 August 2005 Page 26

APPENDIX C – EXPORTING AUDIT FILES

Export Completed Audit

1. Double-click on the Coding Audit

Tool shortcut, , created after downloading the tool..

Depending on the user’s security settings, a Security Warning window may be displayed.

2. Click the button to

The main menu will be displayed listing the various functions for the audit, from importing the pull list, collecting the data to producing reports. The current version of the tool is listed in the blue box on the menu. Ensure that the correct version is being used by comparing it with the current FAQ.

3. When the audit is complete for all

MEPRS3 and APV, click the

5. Locate the folder where the audit will

12 August 2005 Page 27

7. Click the button.

Upload of Completed Audit

1. Open the https://phsd.brooks.af.mil website. Make sure that the address reads https.

The PHSD Sign On page will be

2. Enter the username and initial password and click the

The PHSD home page will be

3. Scroll to the Upload a File Now… section.

4. Select the folder from the drop-down

Note: The page will look different if the user does not have the wizard installed.

The folder will be Home/user name/ ToPHSD

5. Click the link.

The MOVEit Upload Wizard window https://phsd.brooks.af.mil/

12 August 2005 Page 28

The Choose file window will be

7. Locate the completed coding audit.

8. Select the file

“CompletedCodingAudit_9999_YYYY MM_OUT_YYYYMMDD.csv” where 9999= users DMIS and the export.

9. Click the button.

The file will appear in the MOVEit Upload Wizard.

10. Click the button.

Do not change any of the default options in the next window.

11. Click the button.

12. Click the button.

An email will be sent to the user which confirms the File was uploaded.

12 August 2005 Page 29

If the Wizard is not Installed

1. Select the folder from the drop-down

The folder will be Home/user name/ ToPHSD

2. Click the button.

The Choose file window will be

3. Locate the completed coding audit.

4. Select the file “CompletedCodingAudit_9999_YYYY MM_OUT_YYYYMMDD.csv” where 9999= users DMIS and the export.

5. Click the button.

The selected file will appear in the Step 2 field.

Once the file has been uploaded, a confirmation statement will display at the top of the page.

AFMSA INTERNAL CODING METHODOLOGYAPPENDIX D – AUDIT SAMPLE SIZE REQUIREMENTS

12 August 2005 Page 30

APPENDIX D – AUDIT SAMPLE SIZE REQUIREMENTS

The following table provides the number of required encounters to be audited sorted by Primary Care, APV and Specialty Care per DMIS site. If an MTF has 30 or less APV encounters, all encounters will be audited. If an MTF has greater than 30 APVs, then follow the requirement listed in the table.

DMIS

Primary

Care APV Specialty

Care Grand Total

0004 85 37 122 0006 62 70 66 198 0009 81 52 44 177 0010 84 44 128 0013 77 45 122 0014 58 71 82 211 0015 90 35 125 0018 73 50 123 0019 97 21 118 0033 59 62 71 192 0036 83 40 123 0042 59 43 72 174 0043 75 44 119 0045 81 53 48 182 0046 86 41 127 0050 89 37 126 0051 84 42 126 0053 67 35 60 162 0055 67 65 63 195 0059 92 28 120 0062 85 42 127 0066 59 52 78.7 189.7 0073 50 92.5 97.5 240 0074 93 30 123 0076 98 30 128 0077 74 49 123 0078 71 60 67 198 0079 66 72 70 208 0083 77 44 50 171 0084 89 40 129 0085 79 47 126 0090 93 35 128 0093 88 39 127 0094 100 29 129 0095 54 80 96 230 0096 76 53 129 0097 93 27 120 0101 91 34 125

AFMSA INTERNAL CODING METHODOLOGYAPPENDIX D – AUDIT SAMPLE SIZE REQUIREMENTS

12 August 2005 Page 31

DMIS

Primary

Care APV Specialty

Care Grand Total

0106 100 29 129 0112 89 39 128 0113 70 47 68 185 0114 105 20 125 0117 40 109 113 262 0119 77 52 129 0120 65 76 71 212 0128 84 40 124 0129 78 45 123 0203 78 40 118 0248 80 47 127 0252 91 38 129 0287 96 29 125 0310 104 19 123 0326 62 68 130 0335 104 25 129 0338 105 22 127 0356 85 37 122 0363 101 5 106 0364 98 27 125 0366 85 45 130 0395 94 28 122 0413 98 26 124 0629 82 43 125 0633 59 56 82 197 0635 48 45 80 173 0637 86 40 126 0638 67 2 63 132 0639 61 32 71 164 0640 60 34 74 168 0653 85 85 0799 95 13 108 0802 93 35 128 0804 100 27 127 0805 65 64 66 195 0806 93 33 126 0808 75 28 53 156 0814 90 21 111 7139 87 39 126 7200 63 50 113 Grand Total 6283 1344.5 3607.2 11234.7