Medicare Compliance & Reimbursement

Don't get caught off guard by state surveyors or the OIG.  Are you up to speed with the latest developments in Emergency Medical Treatment and Active Labor Act enforcement? The rules changed as of Nov. 10, when the Centers for Medicare & Medicaid Services' Sept. 9 final rule on EMTALA went into effect. And while the changes are generally favorable to hospitals and physicians, failure to fully come to terms with them could leave providers facing steep fines and bad publicity. While CMS hasn't yet issued revised interpretive guidelines for the new EMTALA rule, the agency outlined its enforcement perspective in a Nov. 7 letter to state survey agency directors (Ref: S&C-04-10). The letter includes interim guidance for surveyors to use while official guidelines are being developed. Here are some of the key elements: Dedicated emergency departments must provide a medical screening examination to all patients who present themselves. Patients who present somewhere on the hospital's main campus, but not in a dedicated ED, must receive an MSE only if they request - or someone requests on their behalf - examination or treatment for what may be an emergency medical condition.

EMTALA does not apply at locations off a hospital's main campus that aren't dedicated EDs (such locations must, however, have written procedures for handling emergency situations). Hospitals don't have EMTALA responsibilities toward patients "who have begun to receive services as part of a scheduled outpatient encounter." A hospital's EMTALA obligation ends when a patient is admitted as an inpatient. Warning: EMTALA is triggered if a hospital admits a patient "for the purpose of avoiding its EMTALA obligation." The best way to handle on-call lists remains unclear. CMS says on-call lists must be assembled "in a manner that best meets the needs of hospital patients receiving required EMTALA services, taking into account the services offered by the hospital and the availability of specialty physicians who take call." Hospital-owned ambulance services should be well integrated into local emergency medical service networks. EMTALA probes should be initiated only when someone makes a complaint. To see the guidance, go to www.cms.gov/medicaid/survey-cert/sc0410.pdf. Lesson Learned: Hospitals and emergency physicians should make sure they're on top of the latest EMTALA mandates.