DNFB Backlog, Remote Coders, and an Incoming Acquisition

Priority 1 - DNFB, because it is cash plus compliance.

$4.3 million unbilled, with roughly $1.6 million aged past 14 days, is at risk of payer timely-filing deadlines and creates a patient-satisfaction and audit problem. Actions: daily DNFB worklist sorted by filing deadline; a named owner per service line; temporary agency or contract coders targeted at the oldest accounts; a root-cause count of why each account is held (missing documentation, query pending, physician response, coding capacity).

Priority 2 - Stabilize staffing where the backlog originates.

Two coding vacancies plus low ROI retention means the backlog will refill as fast as it clears. Decide quickly on fill versus contract, and address ROI turnover with an exit-interview analysis rather than a blanket raise.

Priority 3 - Resolve the remote pilot on evidence, not anecdote.

Priority 4 - Begin acquisition readiness work, because six months is short and integration decisions (encoder, ROI vendor, retention, staffing) need lead time.

Why this order: the backlog has a hard external deadline and a measurable dollar figure; the pilot decision has no deadline and can be settled in a week with data; the acquisition has a fixed date but requires only planning now.

Treat it as an evidence question, then decide and communicate.

What the data show

• The dip was concentrated in the first eight weeks, which is the expected learning curve for new workflow, home equipment, and communication patterns.
• 30 of 34 coders have returned to baseline. That is 88% recovery, which argues the model works and the problem is four individuals.

What to ask for before deciding

• Productivity measured per coder per week, before and after, for all 34 coders - not just the average.
• Accuracy and audit results, not just volume, since speed without accuracy is not productivity.
• Whether the four below-baseline coders are new hires, have home-environment issues, or have an unaddressed management issue.

Decision and management

Keep the pilot, extend it 90 days with individual performance plans for the four outliers, and formalize the standard: productivity and accuracy thresholds, equipment and connectivity requirements, on-site expectations, and a review cadence. Manage the supervisor's concern directly - she may be reacting to loss of visibility, which is a legitimate management problem with a legitimate fix, such as structured check-ins and shared dashboards.

Then communicate: what was decided, the data behind it, the review date, and what would cause the decision to reverse. Avoid reversing a program on an average that hides a recovering trend.

Phase 1 - Pre-close assessment (months 0-2)

• Inventory: record volumes, retention schedule in use, legal holds, open record requests, encoder and ROI vendor contracts, DNFB and denial position, staff roster and licensure.
• Identify regulatory gaps: state retention differences, ROI consent rules, sensitive-record handling.

Phase 2 - Design decisions (months 2-4)

• Single encoder versus interim dual-system operation, with a concrete cutover date and a training plan.
• Replace paper-based ROI with the system's ROI process, including a backlog conversion plan and an authorization form that meets both states' requirements.
• Retention and destruction harmonization: adopt the more protective schedule where the two conflict, and suspend destruction during the transition.
• Staffing: which roles transfer, which consolidate, and how to communicate it early enough to retain the people you need.

Phase 3 - Execution (months 4-9)

• Parallel running with a defined end date, a data-migration validation sample, and a single point of accountability.

Metrics throughout: DNFB days and aging, ROI turnaround, coder productivity and accuracy, turnover, and request backlog. Report monthly to the integration steering committee with risks flagged in writing.