Health Budgets & Financial Policy 2009 UBO/UBU Conference 2009 UBO/UBU Conference Where the Pieces Come Together Date: March 31 Time: 1010 – 1200 Briefing:

Health Budgets& Financial Policy

2009 UBO/UBU Conference2009 UBO/UBU ConferenceWhere the Pieces Come Together

Date: March 31

Time: 1010 – 1200

Briefing: Coding Audit Results

2009 UBO/UBU ConferenceWhere the Pieces Come Together Objectives

Review the Results of the Coding Audit of FY2006 Records, including:– Response Rates– Percent Passing the Audit – Number of Errors Encountered– Types of Coding Errors

Lessons Learned from the Audit Suggestions for Improvement

2009 UBO/UBU ConferenceWhere the Pieces Come Together

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Audit Goals

● Produce Service level estimates of the coding accuracy of Inpatient, Outpatient, and APV records during FY 2006

● Provide feedback to MTFs to enable them to improve their medical coding

● Comply with DoD Directive 6040.41 of April 13, 2004 and DoD Instruction 6040.42 of June 10, 2004

● Validate MHS costs of providing health care to Medicare-Eligible retirees at MTFs during FY 2006, (Medicare-Eligible Retiree Health Care Fund (MERHCF)).


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Audit Methods

Audit Type of Record

Scope of Record Type of MTF Number in Sample

Annual SIDR Inpatient Army 700

Annual SADR Outpatient, Non-APV Army 700

Annual SADR APV Army 700

Annual SIDR Inpatient Navy 700

Annual SADR Outpatient, Non-APV Navy 700

Annual SADR APV Navy 700

Annual SIDR Inpatient Air Force 700

Annual SADR Outpatient, Non-APV Air Force 700

Annual SADR APV Air Force 700

MERHCF SIDR Inpatient MHS wide 400

MERHCF SADR Outpatient MHS wide 400

Audit Samples• 11 random samples of FY 2006 medical records drawn from across

the direct care system

• Total audit size = 7100; SADRS from 276 MTFs; SIDRs from 64 MTFs


Outpatient Results


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• Our goal was an 85% response rate

Overall Outpatient and APV Response Rates by Service Outpatient APV MERHCF Total ARMY 53.64% 85.98% 69.77% 69.94% NAVY 60.00% 89.99% 77.67% 75.27% AIR FORCE 63.08% 90.41% 78.76% 77.00% Total 58.91% 88.79% 74.48% 74.02%


Outpatient Response Rates by Bencat

0

10

20

30

40

50

60

70

80

90

100

AD ADFM DR DS G RET

Per

cen

t OP

APV

MERHCF


Percent of Outpatient Records that Passed the Audit

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Army Navy Air Force

Per

cen

t

With NR

w/o NR

MERHCF with NR

MERHCF w/o NR


Percent of APV Records that Pased the Audit

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Army Navy Air Force

Per

cen

t With NR

w/o NR

Exclude NR & Sequence


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Distribution of the Number of Different Errors per Record Among Audited Records that Failed the Audit.

1 Error 2 Errors 3 Errors 4 Plus Errors

Outpatient

Army 63.64% 25.76% 9.85% 0.76%

Navy 66.33% 23.81% 9.18% 0.68%

Air Force 69.50% 23.40% 6.74% 0.35%

APV

Army 58.02% 30.53% 9.92% 1.53%

Navy 56.24% 30.82% 8.71% 4.24%

Air Force 51.11% 35.56% 10.44% 2.88%

MERHCF outpatient and APV

Army 72.84% 16.05% 7.41% 3.70%

Navy 65.57% 22.95% 11.48% 0%

Air Force 53.70% 29.63% 14.81% 1.85%


Percent of Audited Outpatient Records with any Diagnosis, Procedure, or E&M errors

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Army Navy Air Force

Per

cen

t Procedure Error

Diagnosis Error

E&M Error


Percent of Audited Outpatient MERHCF Records with any Diagnosis, Procedure, or E&M Errors

0

5

10

15

20

25

30

35

40

45

50

Army Navy Air Force

perc

ent Procedure Error

Diagnosis Error

E&M Error


Percent of Audited APV Records with any Diagnosis, Procedure, or E&M Errors

0%

10%

20%

30%

40%

50%

60%

70%

Army Navy Air Force

Per

cen

t Procedure Error

Diagnosis Error

E&M Error


The Most Common E&M Errors in Records that Failed the Audit

Outpatient Army Navy Air Force

E&M not required 14.39% 10.20% 9.57%

TCON coded as office visit 12.50% 11.22% 25.53%

APV Army Navy Air Force

None*

MERHCF Army Navy Air Force

TCON coded as office visit 32.10% 14.75% 11.11%

E&M not required 9.88% 6.56% 3.70%

* None of the services had more than 1% of failed APV records with any E&M error.


The Most Common Diagnosis Errors in Records that Failed the Audit

Outpatient Army Navy Air Force Documentation does not support coded diagnosis

27.65% 24.49% 21.28%

Primary diagnosis not reason for visit 5.68% 2.72% 3.55% APV Army Navy Air Force Documentation does not support coded diagnosis

35.88% 21.65% 30.89%

Primary diagnosis not reason for visit 15.01% 9.65% 10.22% MERHCF Army Navy Air Force Documentation does not support coded diagnosis

20.99% 13.11% 31.48%

Primary diagnosis not reason for visit 6.17% 4.92% 5.56%


The Most Common Procedure Errors in Records that Failed the Audit Outpatient Army Navy Air

Force Codes do not support documentation 23.48% 17.35% 15.96% Missing support documentation 6.06% 7.14% 7.80% APV Army Navy Air

Force Sequencing 25.19% 22.35% 27.78% Codes do not support documentation 28.75% 27.29% 22.89% Missing support documentation 8.91% 5.18% 11.56% MERHCF Army Navy Air

Force Codes do not support documentation 23.46% 26.23% 24.07%


Percent of Audited TCONs Coded as Office Visits

0%

5%

10%

15%

20%

25%

Army Navy Air Force

Per

cen

t

OP

MERHCF


Inpatient Results


Inpatient Response Rate

0%

20%

40%

60%

80%

100%

Army Navy Air Force

Per

cent Inpatient

MERHCF


Percent of Inpatient Records that Passed the Audit Based On Correct DRG

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Army Navy Air Force

Per

cen

t with NR

w/o NR

MERHCF with NR

MERHCF w/o NR


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Percent of “Failed” Inpatient Records with any Diagnosis Errors, Procedure Errors, and Incorrect DRGs.

Any Diagnosis

Errors Any Procedure

Errors Error(s) caused a change in DRG

Army 97.81% 16.79% 51.82 %

Navy 97.40% 12.34% 46.75%

Air Force 96.27% 3.73% 46.27%

Total 97.18% 11.06% 48.24%

“Failed’ Criteria is not limited to incorrect DRG


Distribution of the Most Common Diagnosis Errors among “Failed” Records (includes MERHCF) Error Army Navy Air Force Order Of Diagnosis Not Addressed 32.85% 26.62% 27.61% Diagnosis Not Coded 31.39% 34.42% 30.60% Documentation Does Not Support Diagnosis

22.63% 22.08% 23.88%

Incorrect Admission Diagnosis 22.63% 17.53% 18.66% Complications/Co-morbidities Not Coded 11.68% 21.43% 26.12%

“Failed’ Criteria is not limited to incorrect DRG


Quality Assurance

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Percent Agreement Inter-examiner Reliability (Agreement between the Study Auditor and a Reference

Auditor) Agreement

SIDR 93.42% SADR 96.35%

Percent Agreement for Intra-examiner Reliability(Agreement between the Study Auditor and themselves)

Agreement SIDR 96.49%SADR 97.65%

2009 UBO/UBU ConferenceWhere the Pieces Come Together Summary

Reviewed the Results of the Coding Audit of FY2006 Records, including:– Response Rates– Percent Passing the Audit – Number of Errors Encountered– Types of Coding Errors

Lessons Learned from the Audit Suggestions for Improvement

2009 UBO/UBU ConferenceWhere the Pieces Come Together Speaker Information

<Redacted>

Documents

Health Budgets & Financial Policy 2009 UBO/UBU Conference 2009 UBO/UBU Conference Where the Pieces Come Together Date: March 31 Time: 1010 – 1200 Briefing: