Decoding CFB: The Revenue Bottleneck
Understanding what CFB is—and what it isn't—is the first step toward optimizing your revenue cycle.
What is CFB?
Candidate for Billing (CFB) represents encounters (in both Hospital Billing (HB) and Professional Billing (PB) in Epic) where services have been rendered and charges captured, but the account cannot yet be billed. These accounts are held due to errors, missing information, or specific system edits (DNB checks and Claim Edits).
Why is CFB Critical?
CFB is unbilled revenue. High CFB levels paralyze cash flow, increase operational costs (staff time spent working errors), and significantly raise the risk of timely filing denials. This is especially critical for non-profits managing complex Wisconsin payer requirements (e.g., ForwardHealth/Medicaid).
CFB vs. DNFB
They are often confused. Discharged Not Final Billed (DNFB) typically refers to inpatient accounts held post-discharge, often waiting for final coding or documentation. CFB is broader, encompassing all unbilled charges (outpatient and inpatient) currently held by system edits before claim generation.
Key Performance Indicators (KPIs) to Watch
You can't manage what you don't measure. These are the essential metrics for monitoring CFB health using Epic's reporting tools (Radar/RWB).
1. CFB Days (Velocity)
The Metric: The average number of days accounts remain in CFB status (from date of service/discharge to the date the claim is successfully generated).
Why It Matters: This measures the speed of your billing process. Best practice organizations aim for 3-5 CFB days for outpatient and 5-7 days for inpatient encounters.
2. Total CFB Dollars (Impact)
The Metric: The total monetary value (Gross Charges) of all charges currently held in CFB status.
Why It Matters: This quantifies the scope of the revenue impact. A sudden increase in this metric signals acute process breakdowns (e.g., a new edit firing incorrectly, credentialing issues, or coding backlogs).
3. CFB Aging Analysis (Risk)
The Metric: Categorizing CFB dollars by age (e.g., 0-7 days, 8-15 days, 16-30 days, >30 days).
Why It Matters: Aging helps prioritize efforts. Accounts over 15-20 days old are at high risk for timely filing denials and require immediate, aggressive intervention and root cause analysis.
Interactive Root Cause Analysis
CFB errors originate across the entire revenue cycle. Click on an area below to explore common errors and actionable insights within Epic.
Top Strategies for CFB Reduction
Implementing these best practices can significantly reduce your CFB days and dollars.
- Optimize Epic Workqueue (WQ) Routing and Ownership Ensure every error has an owner and that WQs are routed to the correct department immediately. Do not allow errors to languish in generalized "catch-all" WQs. Utilize Epic's WQ prioritization rules based on dollar amount and age.
- Implement Rigorous Front-End Quality Audits (RQA) Stop errors before they happen. Utilize Epic's RQA features to monitor registration accuracy in real-time. Provide immediate feedback and targeted training to Patient Access staff on common errors (e.g., incorrect plan selection, missing authorization).
- Analyze and Refine Claim Edits & DNB Checks Regularly review your system edits. Are they firing appropriately? Edits that are too aggressive can unnecessarily hold clean claims (false positives), while edits that are too loose allow denials downstream. Analyze the "overturn rate" of specific edits.
- Streamline the HIM/Coding Workflow Reduce the time between discharge and final coding. Optimize the use of Stop Bills and ensure timely responses to physician queries. Incomplete clinical documentation is a major driver of mid-cycle CFB delays.
- Establish Daily Cross-Functional CFB Huddles Create teams (Patient Access, HIM, Billing, IT) to review high-dollar and aged CFB accounts daily. This promotes accountability and rapid resolution of complex, cross-departmental issues.