Corporate Compliance

Tip: Review EMTALA policies

Compliance Monitor, August 26, 2009

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The Emergency Medical Treatment and Labor Act of 1986 (EMTALA) requires that all emergency rooms participating in Medicare provide a proper medical screening examination to determine whether a patient has an emergency medical condition. If the patient has such a condition, the hospital must either stabilize him or her or appropriately transfer the patient to a more suitable hospital. The Office of Inspector General (OIG) Supplemental Compliance Program Guidance for Hospital advises hospitals to review their policies under EMTALA and offers the following guidelines for compliance with the regulation: 
  • Hospitals should pay particular attention to when an individual must receive a medical screening exam to determine whether that individual is suffereing from an emergency medical condition. This cannot be delayed to inquire about an individual’s method of payment or insurance status.
  • If the hospital’s emergency department is “on diverson” and an individual presents to the ED for evaluation or treatment of a medical condition, the hospital must provide such services despite its diversionary status.
  • When transferring a patient, hospitals must minimize the risk to the individual and prearrange the transfer with the receiving facility. The hospital must provide stabilizing treatment to the patient and ensure that the receiving facility has agreed to the transfer. Moreover, certain medical records must accompany the individual. 
This tip is an excerpt from the Compliance Program Effectiveness Handbook. For more information about this book, visit the HCMarketplace.



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