“DNFB” is Not a Swear Word: How to Master the Discharges Not Fully Billed Report
A patient is discharged, their care is complete, and everyone breathes a sigh of relief. But what happens next? If the final claim isn’t sent, that’s the moment a Discharge Not Fully Billed (DNFB) record is created. It’s a quiet but persistent problem in many healthcare organizations, often building unnoticed until it becomes a significant financial issue.
DNFB: The Silent Problem in Your Revenue Cycle
The DNFB report is simply a list of accounts for which a patient has been discharged but the final bill hasn’t been submitted to the payer. Think of it like a leaky faucet—a small drip doesn’t seem like much, but over time, those drips add up to a flood of lost revenue.
Mastering DNFB isn’t about “swearing” at a frustrating backlog—it’s about proactively fixing the root causes to improve cash flow, protect revenue, and strengthen operational efficiency.
The “Why”: The Hidden Costs of a High DNFB
A growing DNFB isn’t just a metric on a report—it’s a direct, compounding threat to your organization’s cash flow, operational efficiency, compliance risk, and strategic agility.
1. Delayed Cash Flow
When accounts linger in DNFB, the clock on reimbursement hasn’t even started ticking. This means:
Working Capital Strain: The funds you need for payroll, vendor payments, and day-to-day operations are tied up in limbo.
Deferred Investments: Projects like EHR upgrades, new imaging equipment, or expansion plans get pushed back because cash reserves are thin.
Industry Benchmark: According to HFMA, for high-volume facilities, a DNFB average above 3–5 days can significantly disrupt revenue flow and add millions in accounts receivable.
Example: If a hospital with $2M in daily charges carries a DNFB of 7 days, that’s $14M in unbilled revenue at any given time—money that could be working for the organization but isn’t.
2. Increased Administrative Costs
Every day an account stays on the DNFB list increases the workload for multiple departments:
Duplicative Effort: Staff re-checking charts, following up with providers, and verifying documentation that could have been completed earlier.
Overtime & Backlogs: Persistent DNFB backlogs often lead to overtime pay or temporary staffing, driving up labor expenses.
Lost Productivity: Time spent chasing old discharges is time not spent on current cases, causing a ripple effect across the revenue cycle.
Example: A coding backlog in one service line may require HIM staff to set aside time for older DNFB cases, delaying the coding of new discharges and perpetuating the cycle.
3. Risk of Timely Filing Denials
Payer submission deadlines—often 90–180 days from the date of service—are non-negotiable. If a claim “ages out”:
Immediate Revenue Loss: The payer will deny the claim outright.
Low Appeal Success Rate: Timely filing denials are among the most difficult to overturn, as the denial reason is administrative, not clinical.
Compliance Implications: Chronic late submissions can flag you for payer audits or affect contractual performance metrics.
Example: If a $15,000 surgical case misses a 120-day timely filing limit due to missing operative notes, that revenue is permanently lost, regardless of the quality of care provided.
4. Inaccurate Financial Reporting
High DNFB skews your financial statements by holding earned revenue “off the books” until it’s billed:
Distorted KPIs: Revenue, Days in AR, and net collection rates may appear healthier (or worse) than reality.
Poor Forecasting: Leadership may make hiring, budgeting, or capital planning decisions based on incomplete data.
Missed Red Flags: Chronic delays in certain departments may be masked by the aggregate DNFB number, delaying corrective action.
Example: A CFO reviewing month-end revenue without accounting for a $3M DNFB backlog may approve a capital project based on an inflated cash position, only to face a shortfall weeks later.
The “How”: A Step-by-Step Guide to Mastering the DNFB Report
Step 1: Identify the “Why” Behind the “What”
Not all DNFB accounts are the same. Perform root cause analysis to understand why each account is delayed:
Missing/incomplete clinical documentation (e.g., operative notes).
Pending physician queries needing clarification.
Awaiting external lab or imaging results.
Coding backlogs due to staffing or case complexity.
Pro tip: Break your DNFB into categories, track the percentage in each, and focus on the biggest drivers first.
Step 2: Establish Clear Workflows and Ownership
Once you know the causes, create defined accountability:
Assign responsible teams for each DNFB reason.
Prioritize accounts by dollar value, discharge date, and delay reason.
Set Service Level Agreements (SLAs)—for example, coding completed within 48 hours, queries answered within 24 hours.
Implement an escalation process for accounts approaching timely filing deadlines.
Step 3: Leverage Technology and Automation
Technology is your greatest ally:
EHR Alerts: Flag incomplete documentation before discharge.
Automated Routing: Instantly assign DNFB accounts to the right staff.
Dashboards & Analytics: Provide real-time DNFB visibility, segmented by cause, age, and responsible party.
Trend Analysis: Identify recurring bottlenecks—like a department whose cases consistently stall.
Case in point: One hospital reduced DNFB days from 7.8 to 3.2 in 3 months after implementing automated routing rules.
Step 4: Foster a Culture of Collaboration
DNFB is a shared responsibility, not just a billing problem:
Break down silos between clinical, coding, and billing teams.
Physician Education: Show providers the link between timely documentation and revenue, gaining their buy-in.
Regular Reviews: Hold weekly or bi-weekly DNFB meetings to remove barriers quickly.
Recognize high-compliance departments or providers to reinforce positive behavior.
“A DNFB report isn’t just a finance tool—it’s a map that shows you exactly where your revenue is stuck.” — Revenue Cycle Director, Becker’s Hospital Review
Conclusion: From a Leaky Faucet to a Well-Oiled Machine
Managing DNFB is not just a back-office chore—it’s a proactive, cross-functional effort that directly affects your financial health. By:
Identifying root causes.
Establishing clear workflows.
Leveraging technology.
Building a culture of collaboration.
…you can transform DNFB from a hidden leak into a smooth, efficient revenue stream.
MBW RCM Can Help
At MBW RCM, we help healthcare organizations take control of DNFB with custom strategies, workflow optimization, and automation tools. Our experts work side-by-side with your teams to uncover bottlenecks, eliminate delays, and protect revenue.
Contact us today for a DNFB analysis and tailored action plan to accelerate billing cycles and stop revenue leakage before it starts.
