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Tip: Make sure your ER meets EMTALA compliance

Patient Financial Services Weekly Advisor, May 27, 2005

An emergency room (ER) requires flexibility, cooperation, and organization 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.

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.

If the situation is not dire, Egusquiza offers the following breakdown of three common information collection systems that comply with EMTALA:

Option 1: Collection of insurance and payment information after screening

• Registration staff collect only the patient's demographic information.
• A nurse screens the patient to determine whether this is an emergency or nonemergency.
• If the situation is a nonemergency, registration staff collect the rest of the patient's information, including insurance information and an up-front payment. The patient also receives information about payment options if he or she is unable to pay.
• Medical staff treat the patient.

Option 2: Bedside collection of insurance and payment information

• Registration staff collect only the patient's demographic information.
• A nurse screens the patient to determine whether this is an emergency or nonemergency.
• Medical staff treat the patient.
• Using a laptop, registration staff finish collecting the patient's information, including insurance and up-front payment, from the patient's bedside. The patient also receives information about payment options if he or she is unable to pay.

Option 3: Discharge collection of insurance and payment information

• Registration staff collect only the patient's demographic information.
• A nurse screens the patient to determine whether this is an emergency or nonemergency.
• Medical staff treat the patient.
• Registration staff finish collecting the patient's information, including insurance and up-front payment, at the point of discharge. The patient also receives information about payment options if he or she is unable to pay.

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