DNFB Case Study
DNFB Case Study
DNFB Case Study
Case Study: Unlocking $3.1M of Frozen Revenue by Addressing DNFB Backlogs Methodically
Executive Summary
A 250-bed acute care hospital was encountering a growing financial barrier: over $6.4 million in tied up revenue as a result of Discharged Not Final Billed (DNFB) accounts. Siloed coding operations, disparate documentation habits, and insufficient real-time visibility resulted in discharges going unbilled for weeks. Scionis RCM was engaged to evaluate, reorganize, and speed up the hospital’s DNFB processes.
In 90 days, Scionis RCM’s discharge-specific coding processes, CDI reorganization, and real-time dashboards enabled the hospital to recover $3.1 million in net new collections, decrease DNFB backlog by 58%, and automate coding turnaround times by more than 60% without sacrificing full compliance and internal HIM operations.
The Challenge
The hospital was not short on discharges, but too many were stuck in limbo. The challenges were:
- Disconnected coding teams by service lines
- Limited CDI collaboration or query ranking
- No discharge-specific coding procedures
- Inadequate follow-up documentation from reporting physicians
- No real-time visibility into DNFB status by department
This resulted in over 320 old discharges, some older than 7–10 days, remaining uncoded. With revenue in limbo, operational cash flow suffered, and leadership lacked clear visibility into the holdups.
Scionis RCM's DNFB Recovery Strategy
Scionis RCM implemented and designed a strategic, department-level DNFB resolution methodology aimed at root cause correction and repeatable workflow redesign over temporary staffing or catch-up coding.
1. Service-Line Specific Coding Workflows
Instead of using one set of coding rules for all patient categories, Scionis RCM used separate discharge coding protocols for:
- Inpatient: Prioritized ICD-10-PCS and DRG assignments with comprehensive chart audits
- Emergency Department: Emphasis on high-volume, rapid turnaround CPT accuracy, and modifier use
- Psychiatric Services: Coding aligned with treatment plan documentation, counseling sessions, and progress notes
Each department was paired with coders who were knowledgeable in that service line to reduce error and rework.
2. CDI + Coding Integrated Collaboration
We closed the loop between Clinical Documentation Improvement (CDI) staff and coding personnel by having RN-led CDI professionals work side by side with
physicians at discharge.
The proactive model ensured:
- Reduced query response time
- Clearly defined principal and secondary diagnoses
- Decreased documentation uncertainty
- Enhanced DRG assignment accuracy
In due course, query pendency decreased considerably, enabling more charts to be moved to billing within 72 hours post-discharge.
3. Real-Time DNFB Dashboards
The hospital’s legacy system updated information only once a day, with no insight into the causes of why claims were held up. Scionis RCM installed live dashboards that:
- Showed case status by department, reason, and age
- Allowed HIM and finance to drill down uncoded charts by hold reason
- Generated real-time notifications for accounts taking more than 5 day
This move from retroactive tracking to real-time monitoring established immediate accountability across teams.
Results After 90 Days
Key Operational Win: 86% of discharge-ready charts transitioned to billing in 48 hours of final documentation and coding review.
What Actually Solves DNFB Backlogs
- Discharge-specific coding beats generic teams, Service-line experts cut delays and rework.
- CDI alignment is necessary, not choice, Physician collaboration at discharge accelerates documentation quality.
- Real-time dashboards turn stalled revenue into actionable priorities, creating momentum for faster resolution
- Process fixes > Staff additions, Sustainable improvement comes from workflow engineering, not headcount.
- Revenue doesn’t wait, Every day a discharge goes unbilled is a missed opportunity for investment in care.
DNFB is a Blind Spot in Finance, Until You Get It Fixed
DNFB is not merely about aging claims. It’s about money that comes into hospitals and never touches their hands because of poor documentation, disorganized teams, and ancient systems. Scionis RCM injected clarity, framework, and strategy, releasing millions of revenue that was locked away.
Whether you’re stuck weeks behind on uncoded discharges or working with subpar visibility, Scionis RCM can help your organization transition from backlog to billing, faster, cleaner, and with complete compliance.
Ready to Unfreeze Your Revenue?
Don’t let millions remain trapped in your EHR. Scionis RCM excels at converting coding roadblocks into billable results. Let’s discuss how we can decrease your DNFB by as much as 60% in the next 90 days.
Reach out to Scionis RCM today and make delay-of-discharge dollars.
Want to work with us?
Partner with Us to Drive Excellence
in streamlining complex revenue processes, recovering lost revenue, and optimizing cash flow.
With our expertise, you can focus on delivering exceptional patient care while we enhance your
financial efficiency and growth.