Icd 10 Kpis
Icd 10 Kpis
Icd 10 Kpis
Now that youve made the switch to ICD-10, you can look for
opportunities to analyze your progress. By tracking and comparing
key performance indicators, or KPIs, you can identify and address
issues with productivity, reimbursement, claims submission, and
other processes.
For more about assessing and maintaining your ICD-10 progress,
see the CMS Next Steps Toolkit.
You dont have to track all of the KPIs listed belowsome might not be practical or relevant for you.
But even small steps to identify and resolve issues can get you on the road to higher productivity and more
timely claims processing.
Reimbursement ratecents on
the dollar provider receives on
claim versus amount billed
Claims acceptance/rejection
ratespercentage of claims
accepted/rejected during payer
front-end edits (before entering the
payers adjudication system)
Days to paymentnumber of
days from time claim is submitted
until provider is paid
Payment amountsamounts
provider receives for specific
services (focus on high-volume,
resource-intensive services)
www.cms.gov/ICD10
Coder productivitynumber of
medical records coded per hour;
review by individual coder
Daily charges/claimsnumber of
charges or claims submitted per
day
Clearinghouse edits
number and content of edits
required by clearinghouses, or
claims accepted/rejected by
clearinghouse
TIP
Tracking KPIs
separately for each
payer will assist in isolating
the root cause of issues.
Using | KPIs
Establish a Baseline for Each KPI
The first step in using KPIs is to establish a baseline, or a point of comparison, for each KPI youd like to track.
For purposes of assessing your ICD-10 progress, youll want to compare KPIs from before the October 1, 2015,
transition date with KPIs from after the transition date. The pre-transition KPIs will serve as baselines.
Ideally, you either:
l Already have pre-ICD-10 baseline data for some KPIs from your clearinghouse
l
Can generate baseline data through your practice management system, electronic health record, or other
health IT system.
If youre 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 like:
Clearinghouses
Third-party billers
System vendors
If you dont have KPI data from before the ICD-10 transition, your clearinghouse or vendor can help create a
baseline.
TIP
Its best to compare metrics with past calendar
years by month. Seasons can affect statistics, and you
will want to take into account local issues (e.g., impact
of staff vacations, flu season). Keep this in mind when
developing baselines.
www.cms.gov/ICD10