Service Documentation Monthly Journal Source: The Academy of Healthcare Revenue
Optimizing Coding Workflow to Reduce DNFB
Discharged-not-final-billed (DNFB) accounts caused due to process delays in the revenue cycle can be very costly to healthcare providers’ financial health. When providers are not promptly reimbursed for their services, crucial revenue needed to continue to provide those services is unavailable. Unfortunately, despite the importance of minimizing unbilled receivables, Academy benchmarking research has found that, on average, almost 20 percent of surveyed providers’ total A/R is DNFB.
Studies consistently show that many providers often focus on minimizing DNFB by improving the timeliness of the billing and collection process. However, another vital part of reducing DNFB is the optimization of coding workflow, which can be enhanced with three important strategies: using automated technology solutions, enhancing the accuracy and completeness of physician documentation, and improving communication between clinical and HIM departments.
It is important to remember that new technology does not replace staff members, but it does assist with the accuracy and speed of staff members’ workflow. One such technological advancement that has grown more sophisticated —and popular— in recent years is electronic document management (or imaging) systems.
Document imaging systems can make workflow more efficient; studies show that hospitals using these systems are frequently best-performers. One benefit of document imaging systems is the elimination of clutter and confusion. Paper documents, such as documentation notes, often accumulate over time, which can make the location of documents difficult and time-consuming. Document imaging systems make this process easier, as files are stored in the high-capacity system and are easily accessible by searching a database, rather than manually searching through large volumes of paper-based records.
In addition, using document imaging systems saves significant time. When a document is received, it can be scanned into the system, placed in the appropriate record file, and then is immediately and simultaneously accessible by coders as well as clinical staff. This can make DNFB reduction efforts more effective, as coders focus more time on coding charts rather than locating and retrieving necessary documents.
Many coding problems and inconsistencies that cause increased DNFB arise when the medical services provided are not sufficiently documented by clinicians, causing confusion for coders and requiring them to follow up with clinicians for clarifications. When clinicians attend to patients, they may fail to sufficiently document some services, and these services cannot be reimbursed. One health information technician pointed out, “Physicians simply do not record everything they do during a patient encounter. In many cases, they may not even be consciously aware of all the steps they go through to arrive at a diagnosis and treatment plan. And what they do record may not support their choice of a visit level entered on a superbill or other encounter report.”1
To identify trends in insufficient documentation that can decrease coding productivity and increase DNFB, HIM leaders and staff members must monitor clinical documentation, so they can identify areas in need of attention. The best way to do this is by conducting periodic audits of physicians’ documentation. Performing in-depth reviews of what these individuals document can help to determine whether documentation consistently aligns with the services provided.
The previous solutions necessarily point to the importance of effective communication between HIM staff and clinicians. For example, when auditing results are collected, HIM must closely examine the information and develop solutions to fix problematic trends.
Specifically, HIM leaders should regularly sit down with clinical representatives to examine documentation habits, provide education and strategies on ways to improve, and ensure that clinicians have all the necessary tools and information (such as comprehensive charge capture tickets) to assist HIM staff members’ efforts.
Improving coding workflow with technological enhancements, enhanced documentation processes, and effective communication can help HIM departments to reduce DNFB and improve their hospitals’ financial health. In the July issue of SDM, The Academy will look at how healthcare facilities have implemented these solutions and strategies to optimize their coding workflow.
Jennifer Swindle, “Good Documentation: What It Means for Your Physicians and Your Revenue Cycle,” Healthcare Financial Management, September 2006.
The Academy of Healthcare Revenue
The Academy of Healthcare Revenue is a membership-based community that provides healthcare leaders with objective research focused specifically on the healthcare revenue cycle. Members receive an unlimited supply of all research--including benchmarking and best practice reports, implementation tools, monthly journals, attendance to virtual conferences, and more--designed to enable them to improve their revenue cycle processes and financial health from within. Furthermore, The Academy's membership offering is tailored to team members throughout the revenue cycle, from executive leadership to patient access, coding, billing and collections, and clinical staff, helping to drive process improvement efforts revenue cycle-wide. Service Documentation Monthlyis one of four journals written by The Academy of Healthcare Revenue monthly.
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