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Don't Let DNFB Cripple Hospital Cash Flow

Dom Nicastro, for HealthLeaders Media, January 23, 2013

Urge collaboration
"Also, develop a collaborative team within the organization that includes representatives from HIM, coding, quality assurance, and others that meets on a regular basis to discuss ongoing issues. In the beginning, this group may meet weekly, and then taper off to a monthly meeting once improvement is seen. In the end, assign the responsibility of the DNFB monitoring to one individual and ensure that they have the tools and resources to review the report, identify process issues, and make corrections."

In most situations, the CEO or CFO has the HIM director deliver the DNFB rates, Weidemann says. It may differ; for instance, at an integrated delivery system or those in which the coding professionals do not report to the HIM director.

Ultimately, the HIM director should lead the effort to improve DNFB rates and should work with representatives from across many groups:  business office, coding, chargemaster, admitting, case management or utilization review, quality management, and HIM. 

"The HIM director should know on a daily basis what the DNFB is, the expected coder productivity, reason for large dollar amounts on the DNFB, etc., and be able to answer questions to the C-Suite," Weidemann adds.

Successfully monitoring and controlling DNFB lies within understanding its cause, says Darice M. Grzybowski, MA, RHIA, FAHIMA, founder and president of HIMentors, LLC, in Westchester, IL.

A HIM department may struggle with getting records coded, Grzybowski says, while other times it may attempt to code the medical record, but find that key information such as a pathology report or dictated operative report is missing.

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