The Pre-Bill Gap: Understanding the Coding and Documentation Accuracy Problem

This is part 1 of a 3-part series on the pre-bill gap that causes revenue leakage. This part covers how the pre-bill problem has become so prevalent, part 2 will explain how pre-bill issues can be solved with AI, and part 3 will provide a complete solution to prevent revenue leakage.

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Hospitals invest heavily in clinical documentation improvement (CDI) programs to ensure coding and documentation accuracy. However, despite these efforts, a quiet but costly problem continues to drain millions from health systems each year: post-discharge pre-bill leakage.

On a case-by-case basis, the problem doesn’t seem that substantial. Each of these small misses seems minor—but across a hospital with thousands of cases, it adds up to tens of millions in lost revenue.

In an internal analysis of major U.S. hospital systems, 1 in 4 patient encounters contained unrealized documentation opportunities after discharge.

Understanding the Post-Discharge Pre-Bill Gap

There’s an Unmanaged Gap…

The pre-bill gap occurs in the narrow window between patient discharge and claim submission. During this period, documentation and coding teams work to finalize charts, validate codes, and ensure every diagnosis and procedure is captured correctly. Unfortunately, this is often where errors—and lost revenue—hide.

Short lengths of stay, staffing shortages, and the rush to reduce discharged-not-final-billed (DNFB) backlogs make thorough review nearly impossible. Providers frequently update notes or add diagnoses late in the stay, leaving teams little time to review or query before the claim goes out.

This unmanaged post-discharge pre-bill gap perpetuates issues caused by incomplete documentation, undercoding, and inaccurate reimbursement.

…Emphasized by Systemic Barriers

The problem isn’t that teams aren’t doing their jobs—it’s that the structure of modern healthcare makes perfect accuracy nearly impossible:

• CDI and coding staff are stretched thin, unable to review every record, and persistent staffing shortages continue to amplify the problem.
• Providers often update documentation late in the stay, sometimes within hours of discharge, leaving diagnoses uncaptured.
• Discharged, Not Final Billed (DNFB) pressures sometimes prioritize speed over thoroughness.
• Short lengths of stay and weekend or holiday discharges often result in cases being pushed out the door before reviews are complete.

Without better tools and processes, even the most skilled teams can’t consistently close every gap before claims are submitted.

What’s needed is a shift from reactive cleanup to proactive prevention—leveraging automation and intelligent technology to review every case, identify missed opportunities, and direct staff to the charts that matter most.

Why Coding and Documentation Accuracy Matter

Coding and documentation accuracy affects far more than just reimbursement. When documentation fails to capture the true acuity of a patient’s condition, it distorts hospital quality scores, risk adjustment factors, and performance metrics. This can lead to under-representation in case-mix indexes, skewed benchmarking data, and financial penalties tied to perceived inefficiency or poor outcomes.

Inaccurate coding also creates downstream challenges. Denials increase, cash flow slows, and finance teams spend valuable time appealing claims that could have been paid correctly the first time. Meanwhile, overworked CDI and coding professionals face growing administrative burdens as they try to reconcile gaps that should have been addressed before billing.

Inaccurate documentation costs hospitals twice—once in lost revenue, and again in wasted effort.

The Solution? AI-Enhanced Tools to Fill the Pre-Bill Gap

Emerging AI-enhanced tools now allow hospitals to review 100% of discharges, pinpointing documentation or coding discrepancies in real time. Instead of combing through charts manually, CDI reviewers are guided directly to the most financially and clinically meaningful opportunities.

Improving coding and documentation accuracy requires a holistic approach that bridges the space between discharge and billing.

Curious about how much revenue you could be missing?

Ready to see how you can fill that pre-bill gap?