Unlocking $3.1M of Frozen Revenue by Addressing DNFB Backlogs Methodically

Executive summary

A 250-bed acute care hospital faced a growing financial barrier: over $6.4 million in tied-up revenue from Discharged Not Final Billed (DNFB) accounts. Siloed coding operations, inconsistent documentation habits, and no real-time visibility left discharges unbilled for weeks. Scionis RCM was engaged to evaluate, reorganize, and accelerate the hospital's DNFB processes.

In 90 days, Scionis RCM's discharge-specific coding workflows, CDI reorganization, and real-time dashboards helped the hospital recover $3.1 million in net new collections, cut its DNFB backlog by 58%, and speed up coding turnaround by more than 60% — all without sacrificing compliance or disrupting internal HIM operations.

The challenge

The hospital was not short on discharges, but too many were stuck in limbo. The root problems were structural:

• Coding teams disconnected across service lines
• Limited CDI collaboration and no query prioritization
• No discharge-specific coding procedures
• Inadequate follow-up documentation from treating physicians
• No real-time visibility into DNFB status by department

This left over 320 old discharges, some already 7-10 days old, sitting uncoded. With revenue frozen, operational cash flow suffered, and leadership had no clear visibility into the holdups.

Scionis RCM's DNFB recovery strategy

Rather than throwing temporary staffing or catch-up coding at the problem, Scionis RCM designed a department-level DNFB resolution methodology focused on root-cause correction and repeatable workflow redesign.

1. Service-line specific coding workflows

Instead of one set of coding rules for all patient categories, Scionis RCM built separate discharge coding protocols for each service line:

• Inpatient: prioritized ICD-10-PCS and DRG assignments with comprehensive chart audits
• Emergency Department: emphasis on high-volume, rapid-turnaround CPT accuracy and correct modifier use
• Psychiatric Services: coding aligned to treatment-plan documentation, counseling sessions, and progress notes

Each department was paired with coders who knew that service line, reducing error and rework.

2. CDI and coding integrated collaboration

We closed the loop between Clinical Documentation Improvement (CDI) staff and coders by having RN-led CDI professionals work side by side with physicians at discharge. This proactive model reduced query response time, clearly defined principal and secondary diagnoses, decreased documentation uncertainty, and improved DRG assignment accuracy. Query pendency dropped considerably, moving more charts to billing within 72 hours post-discharge.

3. Real-time DNFB dashboards

The hospital's legacy system updated only once a day, with no insight into why claims were held. Scionis RCM installed live dashboards that showed case status by department, reason, and age; let HIM and finance drill into uncoded charts by hold reason; and generated real-time alerts for accounts aging past 5 days. This shift from retroactive tracking to real-time monitoring established immediate accountability across teams.

DNFB is a blind spot in finance — until you fix it

DNFB isn't merely about aging claims. It's about money that hospitals earn but never actually receive, because of poor documentation, disorganized teams, and outdated systems. Scionis RCM injected clarity, structure, and strategy, releasing millions in revenue that had been locked away. A key operational win: 86% of discharge-ready charts moved to billing within 48 hours of final documentation and coding review.

Whether you're weeks behind on uncoded discharges or working with poor visibility, Scionis RCM can help your organization move from backlog to billing — faster, cleaner, and with full compliance.