How LCMC Health Recovered $13M in Uncaptured Revenue with Physician-Led Pre-Bill Reviews

As health systems navigate rising costs, rapid growth, and increased payer scrutiny. The accuracy of medical records has become a critical driver of both revenue integrity and high-quality healthcare. For LCMC Health, an 8th-hospital nonprofit system based in New Orleans, closing documentation gaps was essential not only for reimbursement but to improve patient care across a growing company.

By partnering with Enjoin and implementing physician-led pre-bill reviews, LCMC Health successfully aligned clinical documentation improvement (CDI), coding, and physician engagement. As a result, they achieved nearly a 3% increase in their case mix index (CMI) and recovered $13 million in previously uncaptured revenue.

About LCMC Health

LCMC Health, a nonprofit health system rooted in the vibrant city of New Orleans, Louisiana, proudly operates a wide-ranging network that includes eight hospitals and over 2,800 dedicated physicians. This network encompasses a range of facilities, including academic medical centers, community hospitals, and urgent care centers.

Excitingly, as LCMC Health continues to grow, recently launching a heart transplant program, it recognizes the importance of standardizing medical records practices. This thoughtful initiative is designed to enhance health outcomes and achieve financial sustainability across all facilities, ensuring that our community receives the best possible care.

Where Documentation Breakdowns Were Costing Millions

When Jackie Josing, RHIT, CCS, became Vice President of Revenue Management at LCMC Health, she entered a complex environment marked by renewal and improvement in health.
Throughout the system, clinical documentation improvement (CDI) and coding processes varied significantly, physician involvement was inconsistent, and documentation often did not accurately reflect the severity of patients’ illnesses. These issues resulted in missed diagnoses and ongoing revenue loss.

LCMC needed a clear understanding of which diagnosis-related groups (DRGs) were most at risk and how to fix those issues before submitting claims.

A Shift to Physician-Led Pre-Bill Reviews

LCMC partnered with Enjoin and joined its Pre-Bill DRG Assurance Program. This program ensures documentation is correct before claims are sent to insurance companies. It encourages teamwork between clinical coding analysts and certified physicians, rather than fixing errors later.
Each month, LCMC receives a tailored list of DRG performance areas that require improvement in patient care, helping teams focus on making the most impact. This physician-led model ensures that documentation, coding, quality data, and payment processes are aligned. It supports compliance and enhances patient care.

Measurable Results That Matter

In April 2024, LCMC initiated a pilot program for pre-bill review and subsequently expanded it to encompass seven hospitals. Within a period of 12 months, the effects of this initiative became evident:

• Almost 3% system-wide increase in CMI
• $13 million in uncaptured revenue recovered
• Greater consistency in CDI and coding practices across facilities

For a nonprofit health system, the recovered revenue directly supported reinvestment in clinical programs, staffing, and patient services, reinforcing the connection between accurate medical records and improvement in health.

Support Beyond the Initial Claim

Enjoin’s involvement doesn’t stop once a claim is submitted. When payer denials occur, Enjoin supports improving patient care by appealing claims that have undergone pre-bill review, leveraging nationwide payer insights and deep clinical expertise to ensure quality healthcare.
“They stand behind their work,” Josing explains. “Their understanding of payer behaviour has been incredibly valuable to our team.”

Education That Drives Sustainable Improvement in Health

Pre-bill reviews offer valuable education that helps improve overall performance at LCMC. Instead of fixing problems one at a time, LCMC gets ongoing feedback that is both timely and relevant. This feedback includes daily guidance related to specific cases, along with clinical and coding references. Additionally, LCMC holds quarterly education sessions that focus on broader trends and developments. The education model, led by physicians, is well-received by both coders and Clinical Documentation Improvement (CDI) staff.
“The education is incredibly relevant to what we see every day,” Josing says. “It’s practical, interactive, and it actually sticks.”
This approach has been especially effective in aligning policies and practices across newly acquired hospitals, a persistent challenge for improving patient care.

Strengthening Physician Engagement with Advisor Support

To further bridge the gap between clinical care and coded data, LCMC launched a physician advisor program supported by Enjoin. The program embeds physician advisors into hospitals to support CDI collaboration, documentation education, and communication between care management and coding teams.
Jennifer Meyer, MD, MPH, Vice President of Medical Affairs, oversees the initiative and emphasizes how subtle documentation details can significantly affect DRGs, quality metrics, and payment.
“Even excellent clinical notes can fall short if a single key term is missing,” Meyer explains. “Physicians don’t always realize how much language matters.”
Through training, Meyer gained deeper insight into how medical records translate into reimbursement and quality reporting, knowledge she now helps share with frontline clinicians.

Building a Long-Term Revenue Integrity Strategy

Looking ahead, LCMC plans to expand the physician advisor model into utilization management, with the goal of reducing denials and improving quality health care.
“If documentation is strong and accurate from the start, we should see fewer denials and smoother reimbursement,” Meyer says. “Enjoin has been a true partner in helping us get there.”

Why Health Systems Choose Physician-Led Pre-Bill Reviews

Health systems adopting physician-led pre-bill reviews benefit from:

• More accurate medical records
• Improved alignment between care delivered and care documented
• Reduced administrative burden from audits and appeals
• Stronger protection against payer denials
• Sustainable improvement in health system performance

We partner with health systems to enhance patient outcomes through in-depth clinical expertise and advanced CDI practices, promoting revenue integrity, compliance, and the accurate translation of care across the continuum.