Know 6 key points of EMTALA bulletin

The special advisory bulletin on the Emergency Medical Treatment and Labor Act (EMTALA), jointly issued by the Office of the Inspector General in Washington, DC, and the Health Care Financing Administration in Baltimore, provides the following key clarifications, according to Caral Edelberg, CPC, CCS-P, president of Medical Management Resources, a Jacksonville, FL-based emergency medicine coding and consulting firm.

1. Appropriate medical screening examinations are mandated for any person who comes to the hospital seeking emergency medical services. Those examinations must include any and all services necessary and available at the hospital, including medically appropriate ancillary services required to stabilize the medical emergency as well assurance of patient transfer to a hospital with necessary services.

2. Hospitals may not delay a medical screening exam or stabilizing medical treatment to inquire about "method of payment or insurance status."

3. Sanctions and exclusion from the Medicare program are applicable to both hospital and physicians.

4. Enrollees of managed care plans are provided protection from preauthorization prior to a medical screening examination as EMTALA prohibits requiring members to seek prior authorization for emergency medical services, defined under the prudent layperson provisions. Further, the bulletin clarifies that "no contract between a hospital and managed care plan can excuse the hospital from its anti-dumping statute obligations." The hospital must provide the services required under the anti-dumping provisions.

5. Issues relating to dual staffing of emergency departments by hospital ED physicians and managed care organization (MCO) physicians to facilitate emergency department management of MCO enrollees have emerged as problematic when non-managed care enrollees incur discrimination in receiving prompt and appropriate medical screening examinations.

The bulletin clarifies that the dual-staffing arrangements must ensure that patients receive equal treatment by ED and MCO physicians, and neither may delay provision of medical screening to inquire about method of payment. Dual-track emergency departments must be adequately staffed and provide good access to all medical capabilities of the hospital to ensure all patients are treated equally.

6. Hospitals should be aware that Medicare and Medicaid managed plans are restricted from requiring prior authorization for emergency services and must pay for emergency services whether or not the hospital participates with the plan. The prudent layperson standards apply.