Friday, July 22, 2011

DNFB, AR, Bill Hold and Other Things You Need to Know Before You Interview at a Hospital

I've interviewed my share of individuals who come in with a padded resume who discredit themselves in about 5 minutes. It has nothing to do with a coding test, education, or certifications. They don't know what the DNFB is. And that is tell tale sign that they have never worked in a hospital coding department before. I can deal with inexperience and honesty. I have trouble accepting lying and deceit.

And while I can't give you all experience, I can let you in on some important coding lingo and explain why it's so important. DNFB stands for "discharged, not final billed." It means - every account held for billing for some reason. Some hospitals refer to it as AR (accounts receivable) or simply "the unbilled." The reasons for unbilled accounts are generally categorized into 3 major buckets:
  • Accounts within suspense (also known as the bill hold) is a facility-defined number of days in which an account will be held from billing so charges can be entered after the patient is discharged from the hospital. Any charges added after the suspense period, which typically ranges from 3-5 days, are considered late.
  • Accounts outside of suspense and not coded - charts awaiting coding before bill drop.
  • Accounts outside of suspense and not billed - charts that have been coded but are being held by billing until issues are resolved (e.g., awaiting late charges)
The concept is simple - the patient receives services, charges are entered, the record is coded and billed. The execution is complicated and the process can hit a number of hiccups before the bill gets out the door.

An informed coding manager can tell you any given day where the facility's DNFB is sitting, particularly those that fall outside suspense and have not been coded. An effective coding manager reports the DNFB to his/her coding staff on a daily basis, keeps the unbilled accounts at a dollar figure the CFO can live with, and can tell you why accounts haven't been coded.

In my experiences with DNFB cleanup as a consultant, I can tell you, it's often not a shortage of coding staff that leads to a high unbilled report. At one client, I was given unlimited coding resources, but as I looked outside my office at the empty shelves that were supposed to be filled with paper records (this was about 10 years ago), I remember telling my boss not to send me more coders but to send me people who could find charts instead. This began a major search in the hospital for medical records that never came down from the floors. Today as we pave the way for electronic health records, there are still a lot of facilities using paper that is then scanned into an electronic format, so tracking down this paper is still an issue for some.

In short, DNFB is not just every coding manager's responsibility, it's every coder's responsibility. You should be prepared to react to fluctuations in the DNFB - when it's high, you may be asked for overtime, denied time off, or taken off other projects that don't contribute to dropping bills (e.g., going to educational seminars). If you're being trained in a new area of coding but are proficient in another, you may be asked to revert to your level of experience before continuing your training.