D190 Task 2 Data Analysis Memo Example

Memorandum

To: Director of Health Information Management, Lakeview Regional Hospital

From: HIM Data Analyst

Date: September 29, 2026

Re: Trends in unbilled accounts, coding turnaround and open physician queries, October 2025 to September 2026

Purpose and Bottom Line

You asked for an analysis of the past year's revenue cycle data from the HIM department. The main finding is that the dollar value of accounts discharged but not final billed (DNFB) roughly doubled between February and May, when two coding positions were vacant, and has not returned to its fall level even though coding staff are back to full strength. The data point to a second cause that has outlasted the staffing gap: physician queries left unanswered for more than a week. I recommend three actions below.

The Data

The table summarizes the monthly figures from the abstracting system, the patient accounting system and the query tracking log. DNFB is measured on the last day of each month.

Trend 1: The Spring Rise Followed Coding Vacancies, Not Volume

Discharges stayed within a narrow range all year, from 1,180 to 1,320 a month, so patient volume does not explain the change. DNFB rose from about $2 million in October and November to a peak of $4.6 million in April, and average time from discharge to coding more than doubled, from 3.1 days to 6.9 days. The rise began in January, when the first coding position became vacant, and was steepest in February through May, when two of nine positions were empty. When two contract coders started in June, DNFB fell by $1.3 million in one month. Measured per discharge, unbilled dollars went from about $1,740 in October to about $3,740 in April and were about $2,260 in September.

Trend 2: Queries Open Longer Than a Week Tripled and Stayed High

The number of physician queries open for more than seven days rose from 12 in November to 41 in May, more than three times higher. Unlike coding turnaround, this measure has not recovered: it was still 29 in September, about twice the fall level. An account cannot be final coded while a query about its documentation is unanswered, so unanswered queries hold revenue regardless of how many coders are working. This is the most likely reason DNFB has settled around $2.6 to $2.8 million rather than returning to $2.0 million.

The query backlog may have started as a side effect of the vacancies, since coders who were behind had less time to follow up on queries, but it now appears to have its own momentum. Physicians' experience of queries matters here. In a qualitative survey of hospitalists and surgeons at a safety-net academic medical center, physicians accepted the importance of documentation integrity but described queries as disruptive to their workflow and emotionally taxing, and many saw physician advisors as trusted leaders who improved communication and engagement (Nepal et al., 2026).

Trend 3: A Smaller Winter Rise Before the Vacancies

December and January show modest increases in DNFB and turnaround before any major staffing change. January had the highest discharge count of the year, 1,320, and the holiday period usually brings coder leave and slower physician responses. This seasonal effect was small, about $0.5 million, but it means the department started the spring vacancies from a weaker position than in the fall.

What the Data Cannot Show

These are monthly totals, so they show patterns but cannot prove cause. To confirm that open queries are holding accounts, we need account-level data showing the reason each DNFB account is on hold: awaiting coding, awaiting a query response or awaiting missing documentation. DNFB dollars also depend on the charges of the accounts on hold, so a few high-cost surgical cases could inflate a month. Finally, filled positions are not the same as coding productivity; new and contract coders may code fewer charts per day than experienced staff.

Recommendations

First, add a weekly DNFB report by hold reason, drawn from the patient accounting system, so that the department can see how many dollars are waiting on queries, coding and documentation separately. This will confirm or correct the explanation in this memo within a month.

Second, create a query escalation path. Queries unanswered after three days would trigger an automatic reminder in the physician's EHR inbox; after seven days, the clinical documentation specialist would contact the physician advisor, who would follow up directly. Query wording and escalation must stay within industry query practice guidelines, which require queries to be clear and non-leading (American Health Information Management Association & Association of Clinical Documentation Integrity Specialists, 2022). Target: fewer than 15 queries open more than seven days by the end of December.

Third, reduce the department's exposure to future vacancies. Keep a standing agreement with the coding contractor so that temporary coders can start within two weeks, and evaluate computer-assisted coding for the highest-volume outpatient and inpatient account types. A narrative review found that computer-assisted coding has shown value for coding accuracy and quality, while stressing that implementation requires sound change management and a redesign of coding workflows (Campbell & Giadresco, 2020). Target: DNFB below $2.3 million and discharge-to-coded time below 3.5 days by the end of the calendar year.

I would be glad to walk through the account-level report with you once the first week of data is available.

References

American Health Information Management Association & Association of Clinical Documentation Integrity Specialists. (2022). Guidelines for achieving a compliant query practice (2022 update). AHIMA.

Campbell, S., & Giadresco, K. (2020). Computer-assisted clinical coding: A narrative review of the literature on its benefits, limitations, implementation and impact on clinical coding professionals. Health Information Management Journal, 49(1), 5-18. https://doi.org/10.1177/1833358319851305

Nepal, S., Allyn, R., Keniston, A., & Pierce, R. (2026). A conundrum in clinical practice: Clinical documentation queries, more money, or more problems? A qualitative survey of hospitalists and surgeons in a safety-net academic medical center. Journal of Hospital Medicine. Advance online publication. https://doi.org/10.1002/jhm.70398