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Quality metrics now shape reimbursement, reputation, and daily clinical operations, so we step back and explain what these measures really are and why they matter. We also dig into where metrics help, where they create burden, and how digital quality measurement could change improvement work in real time. 
• how CMS measures hospital quality across mortality, readmissions, patient safety, patient experience, and timely and effective care 
• quality metrics move from the quality office into finance, strategy, operations, and accreditation 
• the shift toward fewer but more meaningful measures plus interoperability, automation, and health equity 
• benefits of measurement such as accountability, reduced variation, and visibility into complications and infections 
• common failure modes such as documentation burden, measurement fatigue, weak risk adjustment, and missed unmeasured care 
• why physicians support high-value metrics tied to bedside outcomes and reject low-value reporting 
• what patients actually care about and how hospitals can connect technical measures to lived experience 
• 2015 versus 2025 penalty exposure data inferences 
• leadership thoughts: focus, balance outcomes with process, invest in data, shorten improvement cycles, prevent unintended consequences 

If you have any questions or would like to offer a topic to discuss, please email [email protected]. 

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We walk through the newest coding guideline and ICD-10 updates that are driving real questions from coders and CDI teams right now. We connect the rule changes to clinical context so you can spot documentation gaps early and code with confidence. 
• sepsis guideline title change and why antibiotic resistance keeps surfacing in reviews 
• drivers of antimicrobial resistance and common clinical risk factors to capture 
• hypertension with heart disease guideline updates and when additional codes apply 
• sequencing considerations for hypertensive urgency, emergency, and crisis 
• new technology updates including lattice stents, newer defibrillator leads, Fontan scaffold advances, obstetrical dilators, and emerging therapies 
• CAR T therapy documentation watchouts and differentiating CRS from SIRS during reviews 
If you have any questions or would like to offer a topic to discuss, please email info at accuityhealthcare.com. 

Originally Published: 5/13/2026

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We talk with Accuity's Vice President of Revenue Cycle Operations, Jennifer Miecznikoski, about health information management careers and how an HIM foundation can lead to operations, IT, analytics, and revenue cycle leadership. We break down credentials like RHIA, RHIT, and CCS, then look ahead to AI, data governance, interoperability, and HIM paths allowing growth into management roles. 

• Jennifer’s career path from foundations in HIM to leadership of EHR implementations 
• Emerging and expanding HIM career roles
• How DRG integrity work pairs coding expertise with physician review 
• What RHIA and RHIT signal for leadership and technology paths 
• Why CCS and other coding certifications build credibility 
• A practical tip on taking credential exams sooner 
• Where AI, computer-assisted coding, and data governance create new opportunities 
• Advice for moving from coding into leadership through mentoring and research 

If you have any questions or would like to offer a topic to discuss, please email [email protected]

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In this episode, we meet with Britanny Shelledy to break down gamification as a practical way to boost engagement and recall for lifelong learners in healthcare. We dig into where gamification comes from, why it surged after COVID, and how to use it without letting competition distract from the learning goals. 
• defining gamification through game mechanics like points, levels, rewards, and progress tracking 
• tracing the history from badges and loyalty programs to modern apps and digital learning 
• seeing how COVID-era disruption pushed educators toward interactive, morale-building tools 
• sharing real formats we use with residents and attending physicians like Jeopardy and Family Feud 
• outlining core gamification categories such as leaderboards, quests, storytelling, feedback loops, and social collaboration 
• weighing benefits like retention, active learning, teamwork, and data insights against risks like anxiety and misalignment 
• walking through implementation steps: know the audience, set objectives, pick the right type, design, then measure and refine 
• looking ahead to AI-driven personalization and higher-fidelity simulation technology 

If you have any questions or would like to offer a topic to discuss, please email [email protected].

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We explore how nephrology documentation can be both clinically faithful and coder-ready, focusing on AKI vs ATN, linking diagnoses to causes, and reducing avoidable queries. We share practical tactics, from lab trend interpretation to medication reviews, and reflect on AI’s place alongside physician judgment.

• AKI and ATN terminology
• Linking diagnoses to clear etiologies
• Education tactics that make codable language second nature
• Respecting clinical judgment when criteria feel incomplete
• Lab and urine trends that signal early kidney injury
• Medication-induced nephrotoxicity as a reversible cause
• ICU triggers, systemic diseases, and combo codes
• Templates, AI assistance, and human oversight

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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 [email protected].

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Joined by Accuity's Senior Director of CDI, Verona Lodholz, 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 [email protected].

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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

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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, Accuity

• 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 [email protected] with your questions or suggested topics for future episodes.