Critical Rev Cycle Key Performance Indicators

Here's an overview of the essential revenue cycle key performance indicators (hashtag#KPIs) Discharged Not Final Billed (hashtag#DNFB) and Discharged Not Final Coded (hashtag#DNFC) —two metrics critical to maintaining cash flow and operational efficiency within healthcare organizations. It explains how effective monitoring and management of these indicators reduce hashtag#billing delays can, support timely hashtag#reimbursement, and improve hashtag#coding accuracy. The content outlines recommended practices for baselining, analyzing, and monitoring DNFC data, while identifying common factors that influence performance such as hashtag#systemconfiguration, hashtag#workflow changes, and regulatory updates. Designed for Health Information Management (hashtag#HIM) and hashtag#RevenueCycle leaders, the article serves as a practical guide for sustaining KPI compliance and optimizing overall financial performance.

June 10, 2025

Executive Summary

Following is an overview of how the discharged not final billed (DNFB) and discharged not final coded (DNFC) KPIs play a key role in revenue management. Health Information Management applications provide the tools to manage this process with a focus on efficiency and productivity of an organization’s coding resources.

KPI Overview

Discharged not final billed (DNFB) is a summary of balances that have been discharged but have not yet been final billed to the payer. These balances can qualify for DNFB based on standard delays, bill holds, encounters not yet coded and claims that are at the scrubber but have not been submitted to the payer. Once balances are sent to the payer, the balances no longer qualify as DNFB. Actively managing DNFB includes routine reporting, in-depth analysis, and managing exceptions. Successful DNFB management optimizes outcomes, such as accounts receivable (A/R) and cash targets. The first step to managing DNFB is to manage DNFC.

Discharged but not yet final coded (DNFC) is one of many metrics used to measure an organization’s revenue cycle performance. It is a common measurement used by organizations to monitor charts that have been discharged but not yet final coded. While DNFC balance can vary greatly by organization and type of services provided, DNFC days are measurable across organizations. Industry best practice, based on common approach, is an average of 1.5 days or less in DNFC. Many factors can impact DNFC at an organization, including staffing changes, new software, regulatory changes, and process changes.

Baselining and Monitoring

Baselining

It is recommended provider organizations use an average of six months of data to ensure that a normalized trend is used to evaluate the metric. This will serve as your baseline. To do this, you can build to generate the DNFC report for the six-month period to extract this information. It is important to evaluate the data by facility, patient type, and medical service to understand any variances that might indicate an area needs improvement or is performing well.

For this KPI, we baseline the legacy system prior to your conversion. Ensure that the formula used in the legacy system to calculate the KPI is the same as those used in future design specifications. If it is different, determine how to compare this data.

Analyzing the Data

It is important to evaluate the data by facility, patient type, and medical service to understand any variances that might indicate an area needs improvement or is performing well.

Monitoring the KPI

The coding manager and medical records director should monitor DNFC. Further investigation of DNFC is focused on:

• High-dollar accounts waiting for coding
• Providers that have delinquent records
• Coding staff does not meet productivity standards
• Product lines and medical services that have numerous accounts waiting for coding

Impacting Factors

System Configuration: Implementing new software can impact DNFC. Planning needs to include how to mitigate the impact on DNFC.

Workflows: A change in workflow can have a positive or negative impact on DNFC depending on the change. Monitor DNFC closely when making workflow changes.

Content: Content updates (such as ICD-CM, CPT, HCPCS, and groupers) that are not timely or synchronized across the organization can negatively impact DNFC. Proper planning for the change, training, and close monitoring is critical to manage the impact this has on the organization.

Adoption: Staffing can impact the adoption of this KPI; for example, turnover of organization members, maternity leave, and other departmental changes can impact DNFC. Proper evaluation and execution of a plan can help mitigate the impact on DNFC.

Regulatory Requirements: Regulatory changes can impact DNFC. Proper planning for the change and close monitoring is critical to manage the impact on coding productivity.

Recommended Operational Practices

First, we establish process monitor and communicate updates. To mitigate the factors on DNFC, it's recommended that your organization establish a process for monitoring and communicating DNFC.

• Review DNFC daily.
• Evaluate the following areas to determine the root cause if the DNFC is above the recommended 1.5-day balance: Staffing changes. Workflow changes. Outside factors, such as physician documentation.
• Create a committee to evaluate and make recommendations as needed.
• Communicate results and changes to users.

Conclusion

Routing reporting, in-depth analysis, and managing exceptions are all key factors in actively and successfully managing DNFB at your organization. Successful DNFB management optimizes outcomes, such as A/R and cash targets. Recommended best practice keep an average of 1.5 days or less in DNFC to maintain the health of your revenue cycle.

Rev Cycle Department Charge Reconciliation for Acute Setting

Here is a practical framework for achieving effective charge reconciliation within the acute care environment. It outlines a sustainable, two-tiered strategy that balances daily departmental charge reviews with targeted organizational audits to ensure compliance, accuracy, and financial integrity across service lines. By connecting the operational aspects of departmental monitoring with the analytical practices of revenue reconciliation and clinically driven charging, the piece emphasizes shared accountability between clinical and financial teams. Department leaders and finance professionals can use these guidelines to strengthen charge capture processes, minimize revenue variances, and maintain alignment with evolving organizational and system-level reporting standards.

June 10, 2025

Effective charge reconciliation is foundational to maintaining financial accuracy and operational integrity within the acute care setting. Given the high volume of daily transactions across multiple service lines, auditing every charge individually is impractical for most organizations. A more sustainable model combines daily departmental charge reviews with targeted auditing of sample encounters at the organizational level. This dual approach ensures that departments remain accountable for their own charge generation processes while providing a higher-level validation through centralized revenue review—ultimately supporting compliance, financial performance, and data integrity across the facility.

Ideally charges should be audited for each encounter to verify that everything is correct. Realistically this is unlikely due to the sheer volume of charges that can be generated for even a small facility each day. Instead, it would be better to have each department audit their own charges on a daily basis, and then have auditors check charges for a small sample of patient encounters. Using this two-prong approach reduces the workload to a more manageable level that can be sustained by most facilities.

Departments should be checking their charges to ensure that all expected charges are shown on a daily basis. It is recommended that at least the basic auditing be handled at a department level because the departments will be most familiar with what charges should be generated. At a high-level minimum, the departments should be tracking daily volume of charges to get a view of how many charges are coming through; if kept up over the course of a year or so, the view should show if there are unexpected dips in volume that may be due to problems with the building. At a detailed level, the departments should have a good view of what orders have been placed and be able to verify that charges were created correctly. Departments should also combine this with a clinical review, because what happens clinically will affect the charges.

Department level audits should track and fix issues on a day-to-day basis. At the organization level, auditors should pull a sample set of encounters and audit them to ensure all charges were generated correctly. This type of audit can be combined with a coding audit and general check of the record for consistency and accuracy to ensure that all relevant policies and procedures for the site are being followed.

Revenue Reconciliation Review

When reviewing the revenue that posted to a specific cost center, there are many reasons why one could see a variance (+/-) from the baseline revenue metrics. The Revenue Cycle reports are only showing revenue that Posted to the Patient Accounting billing system. Any charges that were held up or suspended before making their way to the billing system will not be shown in this report until the charge reaches a Posted status. The Posted date of the charge will be the Activity Date is one of the report parameters in all our revenue related reports. It is possible that the Posted date and the Service Date can be different if the charge was Suspended or if the documentation that drove that charge was backdated in the system. Another reason a department/cost center could see a variance would be due to an irregularity in scheduled exams or tests. To understand if your department has the correct output of charges for a given day, you need to understand what the input was (how many were scheduled/ordered/completed). The clinical reports discussed in the service line specific to each service will allow a department leader to understand what was clinically performed. This should correlate to what the department charged for and is showing on the revenue reports for their department/cost center. Not all charges are hardcoded in the charge master. Any charge and workflow that involve soft coding procedures or a coding review process will also impact on the time at which certain charges are posted on an encounter. Understanding this process and how it will impact when you are able to report off that revenue for your department will be an important factor for some department/cost centers more than others.

In order to ensure a healthy financial revenue stream for your department, it is imperative that you understand how and what charges drop from documentation and what the revenue routing mechanisms are for your cost center.  It is critical for each department leader to understand and take ownership in the Clinically Driven Charging methods. Any changes to documentation, instruments, machines, or locations all can impact on how a cost center is receiving their revenue. Again, the legacy method of using the CDM to route revenue to your cost center is a thing of the past. To better understand how your cost center is getting credit for which charges, each service line has to make a department/cost center specific CDRC aid that is meant to guide department leaders with understanding how to justify their revenue for a given timeframe.

#chargeeconciliation @Chargingmethods @CDRC @RevenueCyclereports

The Reporting Needs of Main Hospital Rev Cycle Departments

hashtag#reporting requirements and key focus areas for effective Here's an outline of the foundational #revenuecyclemanagement. It highlights twelve primary reporting domains—from General Ledger (hashtag#GL) and hashtag#ChargestoProductivity and hashtag#WorkQueues—emphasizing how each supports accurate hashtag#financialtracking and operational decision-making. The content serves as a practical reference for finance, patient accounting, and revenue management teams, detailing standard report types, their business purposes, and how they align within a broader hashtag#revenueintegrity framework. By defining consistent reporting standards and dependencies across departments, the article helps organizations enhance visibility, streamline reconciliation, and ensure reliable data governance throughout the revenue cycle process.

June 10, 2025

Since there are quite a few areas, we typically make a contingency plan to define the relevant needs of rev cycle departments per the complexity of their reporting needs.

Following is the most common 12 focus areas:

1.     General Ledger

2.     Charges/Revenue, including:

• Revenue and Usage
• Late Charges

3.     Payments, including:

• Payment Plans
• Encounter to collection Agency

4.     Adjustments

5.     Refunds

6.     RVU

7.     Accounts Receivable

8.     Claims

9.     Denials

10.   Census

11.   Productivity

12.   Work queues

Rev Cycle Reporting Standards for Finance & Patient Accounting

AR Reports

Revenue Cycle Aged AR Detail – Purpose to pull your AR by Discharge date based on Primary Financial Class.

Revenue Cycle Aged AR by Financial Class – Purpose to pull your AR by Discharge date based on Primary Financial Class.

Revenue Cycle AR Analysis – This is an AR report but not an aging report. It can be used to find encounter balances, as an AR report.

Revenue Cycle AR Analysis Balance Greater than 50,000 – The purpose to find balances that are greater than 50,000 and this value can be altered to a lower or higher number if desired.

Revenue Cycle Daily AR Summary – Purpose to pull the opening AR, Charges, Payments, Adjustments, ending AR and change in Patient A/R for a given facility for a given date.

Aged Trial Balance by Client – Purpose to pull the AR for Client Accounts only and provide an aging for each client account.  Should be used in conjunction with the Aged AR Detail which will capture Patient AR only.

AR Balance Control – Purpose to pull beginning AR, Ending AR, charges, payments and adjustments for a given date or date range by Billing Entity. This report may be used as part of Month End processes.

Revenue Reports

Revenue Cycle CDM Statistics – Purpose to pull the Revenue and Quantity by Department by CDM.  This can be an interactive report that will group by Facility and Department and pull the total charges and total quantity.   This report may be modified to pull in additional row fields including CDM so that you can analyze your revenue by specific CDMs.

Revenue Cycle CPT Statistics – Purpose to pull the Revenue and Quantity and RVUs by Department by CPT.

Revenue Cycle HCPCS Statistics – Purpose to pull the Revenue and Quantity and RVUs by Department by HCPCS.

Revenue Cycle CDM Item Detail by Activity Date or Service Date – Purpose to pull the revenue grouped by CDM at a patient detail level.

Adjustment Reports

Revenue Cycle Adjustment Summary – Purpose to pull Adjustments that have been entered into the system.  This is an interactive report that will group by Adjustment Sub Type.

Payment Reports

Revenue Cycle Daily Cash Log – Purpose to pull all cash posted at a detailed level that has been entered into the system based on activity date.

Revenue Cycle Daily Cash Collections – Purpose to pull all cash posted at a detail and cube level that has been entered into the system based on Transaction Date.   This report should be run for a small timeframe and should be used as part of the cash balancing process for today’s cash.

Revenue Cycle Payment Summary – Purpose to pull Payments that have been entered into the system.

Payment and Adjustment Summary - Purpose to pull all your payments and adjustments posted for the given timeframe in either a summary output or detailed output grouped by Batch ID.  This report provides you with an opportunity to select EDI only payments, excluding EDI payments or include all.

Non-AR GL Only Account – Purpose to pull all transactions posted to the Non-AR GL Only Accounts.

Financial Transaction Reports

Revenue Cycle Financial Transaction Summary - Purpose to pull all charges, payments and adjustments based on activity date entered.

Claims

Correction Required by Edit Reason – Purpose to pull all claims that failed internal edits and will be grouped by the individual edit.

Claims Submitted – Purpose to pull those claims that were submitted to the scrubber.  This report will be broken out by UB and 1500 and should be set up to run in ops after the claim file was submitted.

Claims Generated by Health Plan – Purpose to pull claim totals for transmitted and submitted statuses only based on Generation date.

GL General Ledger

GL Summary– Purpose to pull the GL information that posted to GL system based on a given date.  The data can be at the summary or detail level and is grouped by the Account Type which includes A/R, Revenue, Cash, Contra Rev, Contra AR, Prepaid, Non-AR GL Only.

GL Alias Detail– Purpose to pull the GL detail for each GL record and allows you to run it for GL status types including Error, Pending and Complete.

Daily Balancing

Daily Balancing Report – Purpose to provide a document daily showing that the tables for charges, payments, adjustments, AR and GL are in balance each day.

Refund Reports

Revenue Cycle Refunds - Purpose to pull all refunds based on creation date, refund status, responsible person, billing entity and facility.

Productivity Reporting

Productivity by Action Code Detail Report- Purpose to provide detailed information regarding action codes applied to patient encounters.  Can be used to help understand an end user’s productivity in Revenue Cycle.

Productivity by Action Code Summary Report- Purpose to provide a summary look at Action codes placed on patient encounters.  Can be used to help understand an end user’s productivity in Revenue Cycle.

Bill Holds Reporting

Billing Holds Report – Purpose to pull a summary and detail for all encounters where there is a hold still present on that encounter.  The grand totals on this report should not be used as a single encounter can be on the report more than 1 time for each different hold.

HIM Med Records Reports

Case Mix Reports

Revenue Cycle Case Mix - Purpose to pull Case Mix based on Primary DRG, Primary Financial Class, Primary Health Plan and DRG. This is an interactive report that will group by the fields mentioned above.  This report can be modified to pull in additional row fields if necessary.

Productivity Reports

Coding Productivity Summary by Activity Month – Purpose to pull coding productivity numbers based on date range grouped by Facility, Coder and Coding Action.   If the encounter is saved as Draft and saved as Final in the same day this will be counted as 1 encounter. If the encounter is opened 10 times during the day and saved as draft each time it will be counted as a count of 1.

Census Reports

Revenue Cycle Encounter Demographics – Purpose to pull Demographic counts for discharges, Avg LOS and patient days.

Revenue Cycle Midnight Census – Purpose to pull census counts for admissions, Avg LOS and patient days.

Revenue Cycle Patient Registrations – Purpose to pull patient registrations and group by Encounter Class, Encounter Type and Primary financial class.

Charges

Suspended Charges Report– Purpose to pull those charges that have suspended and not posted to Revenue Cycle.

In summary, the reporting needs across revenue cycle departments demand a well-structured, standardized approach that aligns financial, operational, and compliance goals. With twelve key focus areas—from General Ledger and Accounts Receivable to Denials, Productivity, and Work Queues—organizations must ensure each domain’s reporting framework is clearly defined and consistently maintained. By leveraging core reports such as Aged AR Detail, Daily Cash Collections, and GL Summaries, stakeholders gain actionable insights to monitor end-to-end performance, identify gaps, and support informed decision-making. A unified reporting strategy not only strengthens financial integrity but also enhances transparency and accountability across the entire revenue cycle continuum.

#GL #AccountsReceivable #Denialsmanagement #Productivity #WorkQueues