Claim Denials

Sift Denials Insight: Non-Covered Emergency Department Denials

Post by
Sift Insights Team

A quick Intelligence Nugget for the week from the Sift Insights Team:

Has your team recently reviewed your non-covered ED denials to understand how frequently patients come to your emergency room to treat mouth/teeth issues? We've seen these treatments be a little sticky with Medicare. Medicare’s LCD is very specific — if you have a dental service diagnosis code, the visit is non-covered. The problem is that providers cannot refuse to screen/assess patients who present to the ED.

Action Items For Your Revenue Cycle Team:

  1. Make sure your team sends these cases to a designated coder to determine if the dental service code is appropriate to use or if it’s unnecessary (based on provider documentation).

  2. Do a review/audit of these claims to ensure they were coded correctly

Need an effective way to slice and dice denials by diagnosis category, group and principal dx code? Sift’s Rev/Track Insights tools (dashboards, reports, working sessions) make it easy.

Want to know more about Sift's Rev/Track Denials Insights? Drop us a line at insights@sifthealthcare.com.

Interested in a *free* Denials Assessment for your health system? Click here to learn more and see if your organization qualifies.

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