Riverside Health System was suffering from increasing accounts receivable (AR) days and high discharge not final billed (DNFB) dollars, predominantly from emergency department accounts. Using Revenue Cycle Compass analytics, they identified $15.8 million frozen in health information management and an underperforming emergency department coding vendor. This revealed that 80% of DNFB dollars were from just two patient categories, with nearly 50% from emergency department patients. By implementing hospital accountability and worklists for coding backlogs, Riverside reduced DNFB dollars by 81.9% and AR days by 7 days within a year.

1. 33060_BusinessOffice_Riverside
REVENUE CYCLE COMPASS
Riverside Health System
700 Beds | Newport News, VA
Riverside suffered from growing AR days month over month. Using Revenue Cycle Compass (RCC)
analytics, they identified dollars frozen in HIM and uncovered an underperforming ED coding vendor
processing accounts at an unacceptable rate, which resulted in high DNFB predominantly comprised
of ED accounts.
CHALLENGE
How can we identify the
cause of outstanding DNFB
dollars and reduce AR days?
Year-over-year reduction in outstanding discharge
not final billed (DNFB) dollars, a decrease of 81.9%
$15.8M
Reduction in DNFB days
7 days
Identify Frozen Dollars
SOLUTION
Riverside needed to pinpoint where the rapid rise in
DNFB dollars was coming from. Their customized
RCC reporting revealed 80% of dollars were
frozen in just two of 13 total patient categories.
Remarkably, nearly 50% of outstanding DNFB was
comprised of ED patients, far higher than the rest
of the RCC cohort.
47.4% of Total DNFB Dollars Held Up in ED
0% 20% 40% 60% 80% 100%
ED Inpatient Amb Surg Other
Total
DNFB
Dollars
RESULTS
Clear Results Stem from Understanding Root Cause Monthly DNFB Dollars
By having users pull their own data, each team was accountable
for their own performance. When asked to share data, they
had to explain when DNFB was going up and why outstanding
accounts had not been worked. This group accountability was
the core driver of success, supported by RCC metrics.
2.68 days
Overall AR day
reduction
7.1 days
DNFB median
performance
5 days
Riverside DNFB
performance
$8.25M
Emergency department
DNFB reduction
$19.3M
$3.8M
Mar
'15
Apr May
Emergency
Patients:
$9.1M
Emergency
Patients:
$893K
Jun July Aug Sept Oct Nov Dec Jan
‘16
Feb
Accountability Is Primary Motivation
Behind Process Changes
PROCESS
1 Hospital Accountability for Performance
Working Group Shares Best Practices
System leaders built account detail worklists for each
facility. These showed the number of accounts waiting to
be coded that were aged greater than four days from
discharge (the length of Riverside’s bill hold). Users were
responsible for reviewing and working these accounts daily.
Riverside’s revenue cycle leaders from each hospital joined
a weekly system level call to track and discuss results.
Each user shared their numbers, instilling accountability
that resulted in a 50% decline in DNFB over the first
month. This success continued over the course of the
year, resulting in a huge decline in overall DNFB.
2
Hospital 1
Worklist
Hospital 2
Worklist
Hospital 3
Worklist
Organizational
DNFB report
Riverside’s
revenue cycle
groups report
results in
weekly
session
Organization
reassess
focus areas