Sift Denials Insight: Non-Covered Emergency Department Denials

• Sift Insights Team
• August 25, 2022

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.

Sift Insights Team

The Sift Healthcare Insights Team provides clients with curated insights around denial and payer trends, revenue cycle automation efforts, and deep analysis around the root causes of denials -- along with actionable recommendations to prevent denials and improve operations.

Justin Nicols

Founder & CEO

A leading industry expert in data analytics technology and has an extensive background in corporate finance and investment banking. Prior to founding Sift, Justin served on the executive team of venture backed ad technology company, and an e-commerce technology company.