Now that you’ve made the switch to ICD-10, you can look for opportunities to analyze your progress. By tracking and comparing key performance indicators (KPIs), you can identify and address issues with productivity, reimbursement, claims submission, and other processes.
First, establish a baseline for each KPI. You’ll want to compare KPIs from before the Oct. 1, 2015, transition date with KPIs from after the transition date. Ideally, you either already have pre-ICD-10 baseline data for some KPIs from your clearinghouse, or you can generate baseline data from your practice management system, EHR, or other health IT system.
If you’re a provider in a small practice, you might not have routinely used or tracked KPIs in the past, so you may need to start by developing a new baseline with current data. Work with your billing and coding staff to see what data are already available in your systems, reports, and records. Check for data available from outside sources such as clearinghouses, third-party billers, and system vendors.
Once you’ve established baselines for your KPIs, compare the data pre- and post-Oct. 1, 2015, to put your current KPIs in context. Tracking KPIs can help you detect problems and identify opportunities for improvement.
CMS KPI checklist for ICD-10
Days to final bill
Days to payment
Claims acceptance/rejection rates
Claims denial rate
Payment amounts
Reimbursement rate
Coder productivity
Volume of coder questions
Requests for additional information
Daily charges/claims
Clearinghouse edits
Payer edits
Use of ICD-10 codes on prior authorizations and referrals
Incomplete or missing charges
Incomplete or missing diagnosis codes
Use of unspecified codes
Return to Provider (RTP)/ Fiscal
Intermediary Shared System (FISS) Volumes
Medical necessity pass rate
TIP: Tracking KPIs separately for each payer will assist in isolating the root cause of issues.
To get the complete CMS “ICD-10: Next Steps for Providers Assessment & Maintenance Toolkit,” go to www.cms.gov/medicare/Coding/ICD10/index.html.
