Feds offer best practices’ advice for EMTALA compliance

In announcing its crackdown on EMTALA violations, the federal government offered a set of "best practices" that it suggests can help hospitals comply. Here is a summary of that advice:

No prior authorization before screening or stabilization.

It is not appropriate for a hospital to request or a health plan to require prior authorization before a patient has received a medical screening examination to determine the presence or absence of an emergency medical condition or before a patient’s emergency medical condition is stabilized.

No financial responsibility or advanced beneficiary notification forms.

Before performing an appropriate medical screening exam, the hospital should not ask a patient to complete a financial responsibility form or an advanced beneficiary notification form, nor should it ask the patient to provide a co-payment for any services rendered. Such a practice could deter patients from remaining at the hospital to receive care to which they are entitled and which the hospital is obligated to provide regardless of ability to pay, and it could cause unnecessary delay.

Qualified medical personnel must perform the medical screening exam.

A hospital should ensure that either a physician or other qualified medical personnel (hospital staff approved by the hospital’s governing body to perform certain medical functions) provides an appropriate medical screening exam to all individuals seeking emergency services. Depending upon the individual’s presenting symptoms, this screening exam may range from a relatively simple one to a complex one that requires substantial use of on-call physicians and ancillary services available at the hospital.

Respond appropriately when a patient inquires about financial liability for emergency services.

If a patient inquires about his or her obligation to pay for emergency services, such an inquiry should be answered by a staff member who is well-trained to provide information regarding potential financial liability. This staff member also should be knowledgeable about the hospital’s anti-dumping statute obligations and must clearly inform the patient that, notwithstanding the patient’s ability to pay, the hospital stands ready and willing to provide a medical screening exam and stabilizing treatment, if necessary.

Hospital staff should encourage all patients who believe they may have an emergency medical condition to remain for the medical screening exam and defer further discussions of the financial responsibility until after the medical screening has been performed.

Follow the proper steps for voluntary withdrawal.

If patients choose to withdraw their request for examination or treatment, the hospital must follow these steps:

1. Offer patients further medical evaluation and treatment that may be required to identify and stabilize an emergency medical condition.

2. Inform them of the risks and benefits of the examination and treatment and of the risks and benefits of leaving before the exam and treatment are provided.

3. Take "all reasonable steps" to secure patients’ written informed consent to refuse the exam and treatment. The medical record should contain a description of the examination and/or treatment that was refused.

Report violations of the anti-dumping statute.

If a nurse, doctor, other staff member or patient thinks a hospital has violated the anti-dumping statute, the incident should be reported to the Health Care Financing Administration office in the region in which the hospital is located.