CMS: Assess your ICD-10 KPIs checklist

March 29, 2016

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