Patients come to EDs seriously ill, injured, and worried, often without any identification or insurance card. In addition to all these challenges, ED registrars also have to keep the Emergency Medical Treatment and Labor Act (EMTALA) law in mind when collecting copays.

“Timing is crucial, and it’s most likely what gets providers into trouble,” says Edna McLain, JD, a partner in the Chicago office of SmithAmundsen.

In general, the key is to ensure any payment request does not impede the medical screening exam (MSE) or any needed stabilization services required to address an emergency medical condition, as defined under EMTALA, says George Breen, JD, chair of the National Health Care & Life Sciences Steering Committee at Epstein Baker Green in Washington, DC.

Whether asking for payment is an EMTALA violation probably depends on exactly when in the ED visit a registrar makes the request. “This requires good communication between registration staff and medical personnel,” McLain says.

ED registrars should bring up payment or insurance only after a MSE and stabilizing treatment has been provided. This means a patient should not be asked about copays or payment during the MSE or while undergoing stabilizing treatment.

Asking for an individual’s basic identification information and emergency contact information are permitted as part of the registration process. “However, registration staff should not delay the MSE or stabilizing treatment to inquire about payment or insurance,” McLain cautions.

Problems occur if registration practices delay the required MSE, medical stabilization, or transfer. “The cardinal rule to remember is that reasonable registration practices are fine,” says Douglas B. Swill, JD, a partner in the Health Care Group at Faegre Drinker Biddle & Reath. “This generally means that staff are not pursuing financial responsibility answers and determinations while the patient who has an emergency medical condition is unreasonably delayed in receiving the MSE — or worse, stabilizing medical treatment.”

If a qualified triage professional determines the patient can wait a reasonable amount of time for the MSE, then further collection of information can occur, as long as doing so does not delay the MSE.

Gathering names, addresses, and even insurance cards may be an appropriate and reasonable registration practice — again, provided it does not delay a timely MSE. Collecting copays before an MSE or stabilizing medical care happens may seem harmless to registrars, but it could land the hospital in trouble.

“It could likely subject the hospital to potential EMTALA violations — or, at the very least, a very challenging response to a federal or state survey team sent to the hospital to assess whether such registration practices violated EMTALA,” Swill cautions.