Background:

AETC is serving as an example in the Air Force for standardizing data quality measures to ensure accurate, complete, consistent and timely reporting of medical record coding. Key to AETC’s success is a command-wide auditing methodology and training approach.

Since 2002, AETC has implemented a structure to ensure coding compliance among all MTFs within the AETC Command. This structure has been collaboratively designed and implemented by Healthcare Resolution Services, Inc. (HCRS).  HCRS delivers auditing and coding training services throughout the command, as well as supplementary medical record coders and administrative staff at clinics across all 13 MTFs.

Solution:

Collaboratively, HCRS and AETC designed and implemented a command-wide auditing and training process to ensure data quality is measured regularly through a standardized on-site audit process at all MTFs’ outpatient clinics. As a result, a standardized coding process was also implemented. Certified coding professionals review medical records and compare coding to documentation thereby identifying strengths and weaknesses in provider documentation, ICD-9, CPT and HCPCS coding. Audits include those mandated by the Air Force Medical Services Agency (AFMSA), individual Command or MTF specific audits, peer review audits, and audits for the Data Quality and Third Party Outpatient Collection System (TPOCS).

Results and Accomplishments:

HCRS consistently delivered seamless training solutions without interrupting the providers’ top priority of caring for their patients. The company demonstrated flexibility by coordinating customized training according to providers’ time and availability.

Outcomes from audits drove focused one-on-one provider, staff and coder training to improve data quality. The other types of solutions HCRS provided include over-the-shoulder training as well as formal presentations to larger groups.  By standardizing the coding, auditing, and training process within AETC and collaborating on a daily basis with specialists from Third Party Collections (TPC) and Information Technology (IT), HCRS helped AETC vastly improve coding accuracy, collect third-party reimbursements, and exceed its business plan goals. HQ AETC frequently reviewed HCRS’ consistent and timely monthly reports which verified the quality of the data. The accurate and reliable data generated confidence for leadership and served as the foundation for budget allocation decisions because they were based on quantifiable results. Furthermore, quality data helped AETC fund the appropriate resources that are dedicated to delivering the highest quality care to our nation’s military and their families. By doing things right the first time, it has streamlined the entire process as well. The success of the project propelled HCRS to the industry’s forefront by demonstrating the best value to its clients as well as taxpayers.

Ongoing training of the Providers, Clinical, Administrative and Coding staff, drives dramatic improvement in coding compliance and accuracy. AETC has improved accuracy by 42% since 2002 (Figure 2). Improved data quality supports resource allocation, RVU and RWP capture, Third Party Collections (TPC) and business plan performance. Most importantly, by standardizing the coding process throughout the command, providers spend less time on administrative issues and are able to dedicate more quality time to patient care.

“Because of HCRS’ standardized auditing and

training process, coding compliance and

accuracy is improving and AETC is leading the

way in reimbursements. Providers, staff and

coders received immediate feedback and were

properly trained. As a result, coding compliance

and accuracy improved dramatically and AETC

is by far the leader in reimbursements.”

–Lt. Colonel Bonnie Goodale, U.S. Air Force,

Tyndall AFB