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Wiki Non-covered OP procedures with ancillary claim lines

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welch129@comcast.net

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Does anyone know of documented guidance to support denial of the entire outpatient claim when the only reason for the service was a non-covered procedure (e.g. cosmetic service)? We understand this is an "unwritten rule"; but we see many claims where the non-covered procedure is denied but all other ancillary services occurring on the same DOS are paid. During audit, the entire claim is rejected, and facilities reimburse the entire claim, but we'd like to find a way to stop the claim prior to payment.
 
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