280-bed critical-access hospital · Meditech Expanse · 9 months
DNFB compressed from 11 days to 4. $4.8M cash unlocked.
CDI rebuild, coding queue rework, and payer policy refresh on a Meditech Expanse stack. Charge capture lifted from 89 to 97 percent. NCR up six points. The cash flow forecast tightened by week ten and held for six months running.
Setting
Critical Access
Beds
280
EHR
Meditech Expanse
Engagement
9 months
Service lines
5 inpatient
Net patient rev
$96M
Result snapshotThe four numbers that moved.
DNFB compression
11d → 4d
ROLLING 90-DAY AVG
Cash unlocked
$4.8M
6-MONTH CUMULATIVE
First-quarter cut
64%
DNFB DOLLARS IN QUEUE
Hospital profile
280-bed
CRITICAL ACCESS · MEDITECH
The compression curve13 weeks. From 11 to 4.
The situationThree causes. One DNFB number. No leverage.
BASELINE
11-day DNFB · $7.7M frozen revenue · the bill-hold report showed a list, not a root cause.
Cause 01 · CDI
CDI was under-staffed.
FTE
1.4
QUERY TAT
5-7d
Cause 02 · Status
Observation drift after discharge.
DRIFT RATE
9%
RE-BILL ADD
3-5d
Cause 03 · Payers
Payer policies were stale.
STALE
12mo+
DENIAL CLIMB
+11%
The fix · workflowOne DNFB queue. Four cause buckets. Cleared daily.
RULE
Every chart carries its cause tag. Same chart never stuck twice for the same reason.
What the dashboard showsDNFB queue by service line. Live cause and aged days.
GREEN
Clearing inside target
AMBER
Bill-hold escalation
RED
Timely-filing risk
DNFB queue · 5 service lines · live
refreshed 22s ago
Med-SurgCause: Charge capture · aged 2.1d
$682K
52%
OR / SurgicalCause: CDI query · aged 3.0d
$914K
75%
Emergency DeptCause: Coding edit · aged 4.4d
$398K
88%
ICUCause: CDI query · aged 4.6d
$521K
91%
Med-SurgCause: Coding sign-off · aged 1.8d
$246K
45%
ObservationCause: Status change · aged 6.2d
$178K
96%
Emergency DeptCause: Missing charge · aged 4.8d
$132K
93%
OR / SurgicalCause: Charge capture · aged 2.6d
$487K
62%
+184 charts in queue · $2.8M total · 1 red · 12 amber
Engagement ScorecardQuarterly partner report · Q4 redacted
CONFIDENTIAL
KPI movement before vs current.
DNFB days · rolling 90d
11.0
4.0
Cash days outstanding
58 d
41 d
Charge capture accuracy
89%
97%
Net collection rate (first-pass)
88%
94%
Denial rate · all payers
12.4%
6.1%
CDI query response, same-day
31%
89%
Q4 · 2026
ASP-RCM Senior Partner
We had reduced DNFB before, but never held it under 5 days. The difference this time was the cause tag on every chart and a same-day CDI response. Six months in, we are still there.
CFO · critical-access hospital
State changeHow the DNFB queue actually looked.
BEFORE
11-day DNFB · $7.4M in queue
- CDI queries averaging 6 days TAT
- No payer-specific necessity library
- Hold-queue review weekly, manual
- Observation status drift on 9% of charts
- Denial rate 12.4% across all payers
AFTER
4-day DNFB · $2.6M in queue
- CDI queries auto-routed, 18h TAT
- Payer-rule library indexed by DRG
- Hold-queue daily, AI-prioritized
- Status changes flagged pre-discharge
- Denial rate 6.1% across all payers
Where the $4.8M came fromTop 8 DRGs by cash unlocked.
TAKEAWAY
CDI loop closure released cash that was sitting in DNFB. Eight DRG families carried 73% of recovery.
CDI loop · productivityWhat the same-day window did to the desk.
Queries per day
42
+183% vs baseline 14.8
Query response TAT
18h
From 5-7 days
Same-day closure
89%
Was 31%
Denied query rate
3.2%
Was 11.6%
Implementation13 weeks. Four checkpoints.
ENGAGEMENT PROFILE
DURATION
13 weeks
FACILITY
280-bed
CASH UNLOCKED
$4.8M
CHECKPOINTS
4
W1 · BASELINE
Map the queue.
12 months DNFB + bill-hold pulled. Cause tags assigned. Roughly $7.7M frozen revenue confirmed.
W3 · RULES
Payer-rule library live.
Commercial + MA medical-necessity rules indexed by DRG. Inpatient-only edits refreshed.
W6 · CDI LOOP
Same-day window enforced.
Remote CDI augment on. Auto-routing by service line. Backlog drained. Query TAT down to 18h.
W13 · HELD
Steady-state at 4d.
DNFB held on rolling 90-day. $4.8M cumulative cash. Six months later still there.
OutcomesBefore. After. In numbers.
Pre-engagement · baseline
DNFB days · rolling 90d
11d
Cash days outstanding
58d
Charge capture accuracy
89%
Denial rate · all payers
12.4%
Frozen revenue ≈ $7.7M / day
Steady-state · month 6+
DNFB days · rolling 90d
4d
Cash days outstanding
41d
Charge capture accuracy
97%
Denial rate · all payers
6.1%
6-month cumulative cash unlock $4.8M
Capability stackWhat the queue actually runs on.
NOT
A spreadsheet
IS
Live in Reporting Cloud
LAYERS
4 with one audit boundary
EVERY HOLD
Writes to PHI access log
Layer 04 · AI
AI Suite · CDI query assist · Coding AI · Denial Prediction
▼
Layer 03 · LLM Gateway
Single audited choke point · cost meter · prompt registry
▼
Layer 02 · Platform
Reporting Cloud · DNFB queue · Meditech Expanse bridge
▼
Layer 01 · HIPAA-eligible AWS
AES-256-GCM PHI · row-level RBAC · PHI access log
Common questionsFrequently asked: DNFB compression.
What is DNFB?
Discharged Not Final Billed. It is the dollar value of completed inpatient and outpatient episodes that have left the building but have not yet dropped a final bill to the payer. Every day a chart sits in DNFB is a day of cash that is owed but uncollectable. For a hospital this size, one day of DNFB is roughly $700K of frozen revenue.
Why does 4 days matter as the target?
HFMA leading-practice for community and critical-access hospitals is a DNFB under 5 days on a rolling 90-day average. At 4 days the hospital sits below that line consistently, which means cash arrives weeks sooner, the cash flow forecast tightens, and the AR aging curve stops drifting right. The first 4 days are CDI and coding throughput. Days 5 and beyond are usually queue management failures.
How was CDI fixed at 1.4 FTE?
By moving the CDI workload onto a hybrid model. ASP-RCM senior CDI staff cover the inpatient query load remotely under the hospital's DNV protocol. The on-site 1.4 FTE focuses on bedside rounding and physician relationships. The remote queue runs same-day query turnaround, which the local team could not sustain alone.
Why anonymize the client?
The master service agreement includes reciprocal confidentiality. Numbers and timeline are real. A senior partner can walk you through methodology and host a reference call under NDA once both sides agree.
Can we get a reference call?
Yes, at late-stage diligence with client consent. The reference is typically a 30-minute call with the hospital's CFO or revenue cycle director.
How long until we see results?
The 90-day plan delivers baseline plus CDI, then coding queue, then payer policy refresh. Visible DNFB compression starts in week three when the query backlog drains. Steady-state under 5 days shows up around week ten. The $4.8M cash unlock is cumulative across the first 6 months.
What does the free audit look like for a hospital?
Send 90 days of DNFB and DNFC data, the bill-hold reason report, the CDI query log, and 60 days of denial data with CARC and RARC codes. Inside 30 days you receive a 4-page written audit covering DNFB cause buckets, CDI query yield, coding throughput, payer policy gaps, recoverable cash in dollars, and a 90-day fix plan.
Does this only work for critical-access hospitals?
No. The DNFB compression logic is identical at any scale. Critical-access, community, and regional hospitals all carry the same four cause buckets: charge capture, CDI, coding, and payer policy. The economics shift with volume and case mix. The discipline is the same.
Want the same audit applied to your DNFB?
A free 30-day audit. Send 90 days of DNFB data, your bill-hold report, and your CDI query log. We return a 4-page written audit covering your DNFB cause buckets, CDI query yield, coding throughput, payer policy gaps, and a 90-day fix plan. Yours to keep. No SDR follow-up.