Note from the ACDIS Editor: Read about denials prevention in the new CDI Journal!
by Jess Fluegel
Possibly the greatest financial challenge healthcare organizations face day-to-day is the consistent influx of denied claims. According to a recent KFF analysis, nearly one out of every five claims (19%) submitted for in-network services were denied by HealthCare.gov insurers in 2023, and denials affected an even higher percentage (37%) of claims for out-of-network services. It takes further effort and financial toll for health systems to overturn these denials and get paid for the care they provided to patients.
We don’t always emphasize reimbursement when talking about the reason for CDI, but it can’t be denied that denials are a problem—and increasingly, CDI is the best medicine.
To bring you the most relevant news and advice from the field on denials prevention and management, we have dedicated the May/April edition of the CDI Journal to the topic.
In this edition, readers will find articles about:
- Types, tactics, and structures of denials management across settings
- The role of the CDI denials specialist
- Query templates and denials prevention
- Denials prevention through AI
- The connection between payer denials and CDI queries
- Defeating AI-driven clinical validation denials
- Building a strong auditor-coder partnership through prebill review
- Improving encephalopathy documentation
- Increased scrutiny on False Claims Act risk adjustment diagnosis documentation
- Compliantly navigating the stormy sea of DRG denials
- Recognizing inpatient severity drivers through clinical reasoning
This edition also includes a “Meet a Member” feature highlighting one of our member’s experiences in the industry. The ACDIS team hopes you enjoy this latest edition and find something helpful in its pages. As always, the CDI Journal is a benefit of ACDIS membership. To learn more about joining ACDIS, click here. ACDIS members can earn one CCDS/CCDS-O CEU for reading each edition of the Journal and taking the associated quiz. You can learn more on the full edition download page.
Our next edition will be diving into pediatric CDI topics! Contributing to the CDI Journal is a great opportunity for CDI professionals to share insight with the community, plus you can receive 0.5 CEU per 350 published words (articles tend to be around the 750-1,500-word mark). If you have advice to share on getting started in pediatric CDI, NICU reviews, common diagnoses, or a similar topic, we’d love to receive your submission.
The deadline for the July/August edition is June 1, 2026! You can send your submissions via this form: https://www.surveymonkey.com/r/CDI-journal.
We hope this edition helps you and your CDI program to hold the line against healthcare denials and other unfortunate consequences of inaccurate documentation! Please reach out to me if you have any questions or are interested in writing for our next Journal edition.
Editor’s note: Fluegel is the editor for ACDIS. Contact her at jess.fluegel@hcpro.com.