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We walk through how to distinguish delirium from encephalopathy using DSM-5 criteria, CAM tools, and clear coding pathways, and we show where they overlap and why it matters. We share practical examples, denial risks, and how nurses’ notes fuel better queries and outcomes.

• DSM-5 features and CAM thresholds for delirium
• F-code specificity for intoxication and withdrawal states
• G-code encephalopathy and system-specific hepatic coding
• Overlap of causes and resolution with treatment
• Differentiating waxing and waning vs acute course
• CC/MCC, Elixhauser, PSI 11 and denial risk
• Using nurses’ notes to build strong queries
• Key resources for fast, reliable criteria checks

At Acuity, we're transforming healthcare reimbursement with a provider-driven, innovative approach. If you have any questions or would like to offer a topic to discuss, please email info at acuityhealthcare.com.

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Dawn Carey, Director of Denials and Appeals at Acuity, joins us to explore the evolving landscape of healthcare claim denials and the tactical responses needed to address them effectively. She reveals how AI, payer tactics, and clinical criteria manipulations are creating unprecedented challenges for healthcare facilities struggling to protect their rightful reimbursements.

• Post-COVID changes in denial patterns with auditors using AI to process unprecedented volumes of claims
• Distinguishing between AI-generated and human-reviewed denials is increasingly difficult
• Prepay denials force hospitals to adjust claims before payment, effectively holding revenue hostage
• Payers create their own clinical criteria for denials, often cherry-picking from established guidelines
• Hospitals must break down departmental silos between contracting, revenue cycle, and CDI teams
• Limiting the number of records payers can review through contracts is an effective mitigation strategy
• Regular meetings with payers, tracking strong cases, and leveraging peer-to-peer reviews help overturn denials
• Acuity's AI solutions include Amplify for chart review and new AI applications for denial management
• Interdepartmental collaboration is crucial for addressing increasingly sophisticated denial tactics
• Facilities using Acuity's integrated physician-coder model experience denial rates under 0.5 percent

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CDI Recruitment & Career Pathways

Laura Deiner – Director for Clinical Documentation Integrity, CommonSpirit

• Gives us her thoughts on:
  • Recruitment Focus
  • Hiring Process
  • Onboarding
  • Career Ladder
  • Keys for Candidates
  • Certification

Jen Davis – Recruiter, Acuity

• Joins us to talk through:
  • Ideal Candidate Profile:
  • Career Pathway
  • Hiring Challenges
  • Advancement
  • Extra “Green Flags”

Overall Takeaways:

• CDI careers demand a unique blend of bedside clinical expertise, coding skills, and analytical ability.
• Employers value adaptability, communication, and willingness to learn over prior CDI experience.
• Remote work expands candidate pools but intensifies competition.
• Certifications boost credibility but are often gained after entering the field.

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Episode Outline:

• Phoenix Criteria overview
• Challenges identified with Phoenix Criteria as stand-alone Sepsis diagnostic tool
• The payer landscape: Reimbursements & denials
• Considerations for CDI professionals conducting chart reviews


Email info@acuityhealthcare.com with your questions or suggested topics for future episodes.