Emtala, Asking For Financial Information

[Petep623]

What is the name of your state?Arizona

This really isn't a Mal-Practice related question.

Under EMTALA, if a patient presents to the emergeny room, when and can they be asked for financial information such as medical insurance? When can they sign a financial agreement?

 

[ellencee]

Under EMTALA, if a patient presents to the emergeny room, when and can they be asked for financial information such as medical insurance? When can they sign a financial agreement?

When the patient "signs in" the ER, the admission process begins. At any point in the admisssion process the financial information may be obtained. The admission paperwork, specifically the consent to receive services, is a financial agreement to pay for services.

The law to which you refer is known as the anti-dumping law and requires that a patient's condition be stablized before the patient is transferred to a facility that accepts and provides indigent care.

EC

 

[purple2]

Standard practice in an ED is to only ask for 1-2 patient identifiers after triage and before treatment begins, as long as asking for the identifiers does not delay or impede treatment in any way.

Asking for financial information outside of those boundaries is generally considered a poor practice.

 

[ellencee]

purple2
I usually agree with your posts but this time, you are off the mark. Social etiquette does not apply to determining if the patient qualifies for services from the ER. Proof of insurance can be asked for immediately and usually is. If the patient can not pay for services rendered and the hospital is not required to provide indigent care beyond urgent stablization of the patient, the hospital (ER) can REFUSE to see the patient.

Usual and standard practice is to sign in and provide your insurance card or state how you will pay for services BEFORE the triage nurse even sees the patient (except for those in obvious life-threatening distress).

EC

 

[purple2]

My post did not refer to social etiquette.

http://www.hcpro.com/content/41672.cfm?

http://oig.hhs.gov/fraud/docs/alertsandbulletins/frdump.pdf (See pg. 3, which states: “It is normally permissible to ask for general registration information prior to performing an appropriate MSE. The hospital may not, however, condition such a screening and further treatment upon the individual’s completion of a financial responsibility form or provision of a co-payment for any services.”)

Most hospitals appropriately carry this out by collecting financial info only when it does not delay triage or further care.

 

[ellencee]

Most hospitals appropriately carry this out by collecting financial info only when it does not delay triage or further care.

Exactly; and if you have to leave the registration window for triage and from triage do not immediately receive entrance into the treatment area, you will be returning to the registration window to complete the registration process which includes providing insurance information and signing an agreement to pay for services rendered. If you are whisked off to surgery or such, you can bet the financial agreement will be signed as soon as you are alert and oriented or an appropriate representative arrives and can sign on your behalf.

A hospital is a business; it charges for services provided and is paid for services provided and consumers are responsible for paying for the services they receive, whether through personal insurance (with or without co-pay), private pay, or taxpayer-funded programs. It is not poor practice to gain the financial agreement, insurance cards, etc. at the first available opportunity; it is usual routine and justly so.

EC

 

[purple2]

OP and other hospital providers:
I just attended a conference with CMS yesterday on this topic, conducted by EMTALA investigators. Their interpretation and enforcement of EMTALA is much more strict than what was discussed in this thread.

You may contact me through http://www.hccny.50megs.com if you need further information.

 

[Buckley]

bump----------------------

 

[ablessin]

Exactly; and if you have to leave the registration window for triage and from triage do not immediately receive entrance into the treatment area, you will be returning to the registration window to complete the registration process which includes providing insurance information and signing an agreement to pay for services rendered. If you are whisked off to surgery or such, you can bet the financial agreement will be signed as soon as you are alert and oriented or an appropriate representative arrives and can sign on your behalf.

A hospital is a business; it charges for services provided and is paid for services provided and consumers are responsible for paying for the services they receive, whether through personal insurance (with or without co-pay), private pay, or taxpayer-funded programs. It is not poor practice to gain the financial agreement, insurance cards, etc. at the first available opportunity; it is usual routine and justly so.

EC

I agree..... also - generally speaking, the registration staff collections insurance information....but the rendering physician normally doesn't know that patients insurance information - or lack thereof.
All the physician is concerned with is treating the patient to a stable condition.