ACDIS CDI Industry Overview Survey: Norwood analysis reveals denials blind spots, OP CDI sluggishness

75% of CDI leaders don’t know their denial rate. That should scare every CFO.

The ACDIS CDI Week Industry Overview survey is out. Nearly 800 respondents answered questions related to engagement, denials, outpatient CDI, productivity, and more.

Here’s a few observations.

Provider engagement levels are good but not where they need to be. About 57% of respondents said that providers are “somewhat engaged,” meaning “they understand CDI concepts but inconsistently put them into practice or do so incorrectly.” 32% stated their providers were very engaged, meaning they “understand the importance of CDI and actively participate in documentation integrity efforts.” Those numbers should be flip-flopped.

Inpatient chart review productivity remains surprisingly flat. We’re surprised chart prioritization and AI powered diagnosis surfacing tools haven’t moved the needle further. Prioritization software (77% use it) is ubiquitous, and computer assisted physician documentation (CAPD) is commonplace and poised for more growth. Yet most respondents (60%) reported averaging 6-10 new reviews and 6-10 re-reviews (35.05%) daily, about the same YOY. This is not a criticism of CDI professionals, just surprise that productivity hasn’t changed much. This possibly speaks to the complexity of patients (higher bar to admission = higher SOI), the sheer number of quality and reimbursement methodologies at play, and chart reviewers tasked with quality and mortality reviews.

Outpatient CDI is growing! Which is great. Just not fast enough for our liking. The number of respondents who said their organization has a stand-alone outpatient CDI department with dedicated outpatient reviewers rose again this year, from 26% to about 31%. Cracking 30% is good but this number should be at 60-70%. The case for OP CDI is crystal-clear; healthcare organizations not in this space are leaving staggering returns on the table. Most orgs (76%) review OP charts for risk adjustment, and 51% focus on HCC capture. HCC capture is the most common departmental KPI (55%), a large increase from 2023 (42%). Risk Adjustment Factor (RAF) score came in second at about 47%, up from 38% in 2023. Just 9% (?) track OP CDI denials.

PROBLEM: A large majority of respondents (75%) said they don’t know how many of their inpatient claims result in a denial. This doesn’t mean your average front-line CDI should know exact numbers but they should know the ballpark, and it does demonstrate a misunderstanding of the scope of this problem. The largest denials bucket is private payers (30.67%), with UnitedHealthcare, Humana, and Blue Cross Blue Shield leading the way. ACDIS notes that “judging from the free-text comments of this question, Aetna was close behind.” No surprises there.

If you’re struggling with provider education, OP CDI implementation, denials mitigation, or need additional staff to boost your chart coverage and review numbers, contact us at info@norwood.com.

References

• View the ACDIS CDI Week 2025 Industry Overview Survey: https://acdis.org/sites/acdis/files/cdi-week/Industry-Report-CDI-Week-2025.pdf
• View our solutions page (we specialize in outpatient CDI, coding audits, provider engagement/education, and denials mitigation): https://www.norwood.com/solutions/