You feel pretty good about your ICD-10 implementation. Clean claims are getting filed daily and payments are rolling in. However, are you measuring and monitoring your ICD-10 impact or just keeping your fingers crossed? CMS is encouraging practices to be looking at several performance measures to make sure that any impact is quickly identified and remediated.
In their free publication “ICD-10 Next Steps for Providers – Assessment and Maintenance Toolkit,” CMS lists 18 key performance indicators (KPIs) which provide insight into what impact ICD-10 may have had on crucial back office functions. Further, CMS recommends tracking the KPI’s on a payer-by-payer basis in order to isolate the root cause of the identified impact.
Practices should compare current performance to a pre-ICD-10 baseline or establish a baseline for making future comparisons. If no baseline is available, software vendors and or claims clearinghouse partners may be a source of performance data on some measures. As follows are the specific KPI’s to track:
- Days to final bill
- Days to payment
- Claims acceptance/rejection rates
- Claims denial rates
- 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 authorization 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
CMS also developed a KPI Fact Sheet is explain each KPI and suggest tracking and monitoring. See https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10KPIs20160309.pdf for this information.
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