In light of patients’ higher out-of-pocket costs, registration staff are collecting from ED patients upfront instead of billing them — in some cases, co-pays or deductibles totaling hundreds of dollars. This practice could trigger an Emergency Medical Treatment and Labor Act (EMTALA) investigation, warns Sue Dill Calloway, RN, JD, president of Patient Safety and Healthcare Education & Consulting. Dill Calloway is also vice president of risk and patient safety at Emergency Physicians Insurance Exchange.
To minimize any EMTALA concerns, the medical screening examination and any medical care needed to stabilize an emergent medical condition should never be delayed as a result of obtaining any financial information — including collecting co-pays, says Mark Reiter, MD, MBA, FAAEM, residency director, University of Tennessee-Murfreesboro/Nashville. Reiter is also CEO of Emergency Excellence, an ED consulting firm.
“We would recommend that whenever a physician enters the patient room, the registration staff should excuse themselves and return later,” he adds.
A hospital’s obligation to screen for and stabilize an emergency medical condition cannot be influenced by whether a copay is paid or not, Reiter emphasizes.
“If no emergency medical condition is found, or if an emergency medical condition is stabilized, then a hospital has the right to insist on payment for non-emergent care,” he says.
The Centers for Medicare & Medicaid Services issued a Dec. 13, 2013, surveyor memo on payer requirements and collection practices.1
“Hospitals cannot request payment or co-pays until after the appropriate medical screening is done and they have had stabilization treatment,” Dill Calloway says.
One hospital was fined $40,000 for an incomplete medical screening examination on a patient with fever, chills, and urinary tract infection symptoms.
“The triage nurse told the patient to pay $85 before the medical screening examination, and she left,” Dill Calloway says. “This should be on the radar screen of every hospital.”
REFERENCE
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Centers for Medicare & Medicaid Services. Emergency Medical Treatment and Labor Act (EMTALA) requirements & conflicting payor requirements or collection practices. Available at: http://go.cms.gov/1YBf585.
SOURCES
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Sue Dill Calloway, RN, JD, Vice President, Risk and Patient Safety, Emergency Physicians Insurance Exchange Risk Retention Group, Auburn, CA. Phone: (614) 791-1468. Email: [email protected].
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Mark Reiter, MD, MBA, FAAEM, CEO, Emergency Excellence; Residency Director, University of Tennessee-Murfreesboro/Nashville. Email: [email protected].
