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Verify that your ER meets EMTALA compliance

Health Care Auditing Strategies, March 1, 2005

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Flexibility, cooperation, and organization: An emergency room (ER) needs these characteristics to perform point-of-service bill collection and comply with the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) regulations, says Day Egusquiza, president of AR Systems, Inc, a consulting firm in Twin Falls, ID.

Emergency wards are unpredictable places where systems can easily break down, says Egusquiza, who is also the former director of reimbursement, business services, and contracting at Magic Valley Regional Medical Center in Twin Falls .

Auditors need to understand there are several variations on ER collection systems, which can be used in the same ER depending on patient flow and the nature of emergencies, she says. As an auditor or compliance officer, you should be familiar with common collection processes.

Each system typically requires collecting demographic information (e.g., the patient's name, date of birth, address, and phone number) up-front, and collecting the patient's insurance information and payment method after the medical screening. This is because under EMTALA, hospitals must provide patients with an initial medical screening before mentioning insurance or payment information. At the same time, hospitals should ideally be able to collect the patient's demographic information up-front to create a medical record and perform certain medical functions, such as ordering lab tests.

This is an excerpt from a member only article. To read the article in its entirety, please login.

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