Fallacy KPIs
- 1. Present Day Outcomes Based KPIs
Inefficient and Invalid
• # cases reviewed
• # cases queried (sent request for clarification to a provider)
• % of cases queried
• $ impact
• % increase in CMI
• % queries with DRG changes
• Query response rate
• Query agreement rate
• % increase in SOI/ROM
• % increase in AMLOS/GMLOS
• Provider groups queried
• Query template usage
• Individual providers queried