How LCMC Health Recovered $13 Million in Uncaptured Revenue with Physician-Led Pre-Bill Reviews
Healthcare organizations are under constant pressure to do more with less. Even when care quality is high, gaps in clinical documentation can prevent organizations from being reimbursed accurately for the care they deliver.
That was the challenge facing LCMC Health, an eight-hospital nonprofit health system based in New Orleans. Following several acquisitions, leadership identified inconsistencies in clinical documentation and coding practices across facilities—creating risk for revenue leakage and compliance issues.
To address these challenges, LCMC Health partnered with Enjoin to implement physician-led pre-bill reviews. Over the course of 12 months, the initiative helped recover $13 million in previously uncaptured revenue.
The Challenge: Documentation Gaps Across a Growing Health System
As LCMC continued to grow, several challenges became clear. CDI processes were not consistent across newly acquired hospitals, documentation did not always reflect how sick patients were or how complex their care was, and physician involvement in CDI efforts was limited. In addition, CC/MCC omissions led to missed reimbursement opportunities.
While the quality of care remained strong, inconsistent documentation caused issues with coding accuracy, DRG assignment, and reimbursement.
The Approach: Physician-Led Pre-Bill Review
LCMC enrolled in Enjoin’s Pre-Bill DRG Assurance Program to better understand documentation performance and identify opportunities before claims were submitted.
The program included:
- Physician-led pre-bill chart reviews focused on DRG accuracy
- Monthly, performance-based DRG focus lists
- Collaboration between coding teams and board-certified physician advisors
- Ongoing, case-based education tailored to LCMC’s patient population
By reviewing documentation prior to billing, LCMC was able to correct gaps early, protecting revenue while maintaining compliance.
Strengthening Alignment Between CDI, Coding, and Physicians
One major result of the initiative was better alignment across teams. Regular feedback and focused education helped to:
- Standardize CDI and coding practices across the organization
- Help physicians better understand how documentation affects DRGs and reimbursement
- Reduce confusion and friction between CDI and coding teams
LCMC also launched a physician advisor program that trained clinicians to act as a bridge between care teams, CDI, and coding. This helped make documentation best practices part of everyday clinical workflows.
Measurable Results in Just 12 Months
The impact of physician-led pre-bill reviews was significant:
- Nearly 3% increase in Case Mix Index (CMI) systemwide
- $13 million in recovered revenue
- Improved documentation quality and compliance
- Reduced risk of denials and rework
This revenue reflected care that had already been delivered—now accurately documented and appropriately reimbursed.
Building a Sustainable Model for Revenue Integrity
For LCMC Health, the work didn’t stop with recovered revenue. Strengthening clinical documentation has helped create a more sustainable foundation for future growth.
By engaging physicians earlier in the documentation process and aligning CDI and coding efforts, LCMC is better positioned to improve efficiency, contain costs, and support long-term financial stability, while continuing to deliver high-quality, patient-centered care.