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We talk with Accuity's CFO about underpayment, rising AI-driven denials, and how to trace the cash from clinical care to collected dollars. The strategy blends technology with physician review to lower final denials to around one percent and deliver material, auditable ROI for hospitals of any size.

• financial pressure on hospitals and underpayment
• AI-based denials and due process concerns
• pairing technology with physician-led clinical validation
• focusing on complex cases, CMI, and surgical mix
• material impact at single-site and academic centers
• traceable ROI with 98–99% expected collections
• aligning DNFB speed with net cash outcomes
• breaking silos with shared scorecards and goals

At Accuity, we're transforming healthcare reimbursement with a provider-driven, innovative approach. We share valuable clinical coding insights and current best practices to improve financial outcomes across health systems. If you have any questions or would like to offer a topic to discuss, please email info@accuityhealthcare.com.

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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, PSI 11 and denial risk
• Using nurses’ notes to build strong queries
• Key resources for fast, reliable criteria checks

At Accuity, 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@accuityhealthcare.com.

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Dawn Carey, Director of Denials and Appeals at Accuity, 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
• Accuity'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 Accuity's integrated physician-coder model experience denial rates under 0.5 percent