DNFB in Healthcare: It’s a Marathon, Not a Sprint

DNFB in Healthcare: It’s a Marathon, Not a Sprint

Discharged, not final billed (DNFB) accounts can be a thorn in a health system’s side. While these unbilled accounts sit idle between the patient’s encounter/discharge and final billing, the entity to which they are owed does not collect revenue. As a result, they can prove detrimental to your facility’s Accounts Receivable (A/R) days. Services have been rendered, but you haven’t been reimbursed for them. Cash flow suffers.

There can be several reasons for DNFB in healthcare. Incomplete coding, missing documentation, provider query, waiting for additional system edits to the encounter, or no corresponding charge are among the contributing factors to an increased number of DNFB encounters. In our experience as HIM consultants, we’ve developed several strategies for clients to improve their DNFB benchmark.

What is Trending with DNFB Accounts

Performing periodic, in-depth research into the DNFB, its various contributing factors and specific features, can be an eye-opening experience. All too often there is finger-pointing towards the Coding Department for being short-staffed; there are, however, many other factors that come into play within the DNFB accounts that a daily or weekly report can reveal. Here are some examples:

• System issues: holding claims for several days (after Final Coded) due to various billing edits and internal system processes that need to occur before submission to the payor.
• External factors: reimbursement policies, such as payor contractual resolutions; delayed elective procedures during the height of the COVID-19 pandemic.
• Communication Delays: Delay in provider answered queries or missing documentation so the Coding staff cannot Final Code numerous encounters.
• Data flow: Outpatient series accounts have specific “drop dates” which occur once or twice a month.
• Combined Cases: Some outpatient encounters need to be combined with IP encounters due to the 72-hour rule.
• Hold for Updates: Code updates (10/1, 1/1, and 4/1) may be on hold for the encoder and billings systems updates to sync.
• Data Compilation Errors: Errors in OP charge capture (inflating the DNFB).
• Overarching Health Trends: Trends in more IP high dollar encounters (i.e. COVID, Respiratory Vents, seasonal diseases, etc).

DNFB Isn’t a Sprint – It’s a Marathon

While every hospital CFO is justifiably concerned about their DNFB, Coding and Finance should work together to develop a trending tool as a means of gaining perspective on the long term. While it may be a quick fix to ramp up Coding staff in order to decrease the DNFB, that is often not the solution in the long run. Overtime can be costly, and too much overtime can result in coder burn-out or workflow issues such as not enough encounters to code at the end of the week. Health systems need to find a balance between too much overtime and calculate return on investment for overtime hours vs the decrease in DNFB. Another option for overtime would be to add periodic additional contractor coding hours. An overall visual of the DNFB over a period of time can serve as an insightful tool in gaining perspective on specific items to research.

Example DNFB trending for 1Q

This 1Q trending analysis displays the DNFB for an entire quarter. Note that the highest DNFB ($13.61M) was mid-February, while the lowest DNFB were at the beginning of January ($6.72M) and the last day of March ($6.52M). Items to research would include:

• Was the Inpatient census higher in mid-February?
• Were there more high-dollar accounts during that mid-February timeframe (i.e. COVID)?
• Were more coder vacation hours taken for any week during 1Q?
• Was there a system update any time during 1Q?
• When did the Outpatient series accounts drop during 1Q?
• While Inpatient encounters account for the majority of the DNFB, were there any high or low points for Outpatient encounters?
• Were the bill hold days (typically 2-3 days) changed in 1Q?
• Monday’s DNFB is typically higher due to little weekend coverage – should you implement an incentive for coders to work Sun – Thurs or Tues – Sat?
• What interdepartmental teams are involved in DNFB discussions for solutions (i.e. Coding, Billing, IT, Providers, etc)?

Providing trending reports, along with detailed research, can provide considerable insight into your DNFB, its contours and causes. The first step to strategizing long-term solutions to this complex (and at times vexing) phenomenon is developing a fuller understanding and viewing it in a broader context to determine the underlying factors. High DNFB in healthcare can hit facilities where it hurts. Yet many times the solution is not to work harder (dedicating more coding hours to it), but to work smarter at managing its ebbs and flows from multiple angles.

If you need assistance tackling your DNFB, trust the experts at YES to help you find that solution to address those outstanding accounts. Reach out to our team today.

This article was co-authored by Nicholas W. Youmans, CFO.