It’s no EMTALA violation to get insurance info first
Question: Can we collect insurance information after triage in the emergency department but before the medical screening examination? We hear conflicting explanations about whether this violates the Emergency Medical Treatment and Labor Act (EMTALA). Sometimes, there is plenty of time between triage and the examination, so it would be helpful to get the paperwork in process.
Answer: You can go ahead with collecting insurance and other payment information between triage and the medical screening examination, says Daniel J. Sullivan, MD, JD, FACEP, president of the Sullivan Group, a consulting company in Oak Brook, IL, that specializes in EMTALA interpretation. He answered the question at the recent meeting of the American Society for Healthcare Risk Management in Nashville, TN.
You still need to be careful about how the emergency staff goes about this process, he says, but EMTALA does not prohibit gathering that information at that point, he says. That has always been the case; the recent release of the final EMTALA rule did not change the procedure for when you can collect payment information. "There cannot be any delay in the medical screening examination to obtain financial information," Sullivan says. "But if it does not delay the medical screening examination, it is not a violation."
Confusion arises because, in the past, risk managers have incorrectly interpreted EMTALA to mean that no financial information could be collected until the law had been satisfied by the medical screening examination. Some hospitals enacted rules prohibiting the collection of any payment information until after the examination, and Sullivan says that led to inefficiencies when the patient was off-limits to staff during the wait and then the information had to be gathered afterward when treatment had begun.
Risk managers are reconsidering such restrictions and considering how to comply with EMTALA in the least restrictive way, Sullivan says. The key is to avoid any delay. It is not acceptable for the examination to be delayed even for a short time because other staff still are talking to the patient about financial information, he adds. Sullivan also cautions that any discussion of payment arrangements must not discourage the patient from staying for the examination and possible treatment. This is another reason that some risk managers have chosen to ban such information gathering until after EMTALA has been satisfied by the screening examination: Any discussion of the ability to pay could cause the patient to leave before the examination and that could be interpreted as an EMTALA violation, even if that outcome was entirely unintended.
You can continue to play it safe by waiting until after the examination, but practical considerations are forcing many hospitals to play it closer to the line, Sullivan notes. "EMTALA has been interpreted in the past to mean that you should never collect financial information before the medical screening examination, but in today’s full, very overcrowded emergency departments, it can be OK if carefully constructed," he says.