EMTALA deficiencies are one of the most problematic standards for hospitals, and federal government data shows that many EMTALA deficiencies involve on-call physicians. Hospitals that have an emergency department and accept Medicare or Medicaid reimbursement, including critical access hospitals, must follow federal law and CMS interpretive guidelines on EMTALA. The current CMS deficiency report found over 2,667 EMTALA deficiencies and there were 126 cases related to on-call physician issues.
Also, revisions to the HHS OIG’s Civil Monetary Penalty Rules more than doubled the civil monetary penalties (CMPs) for violating EMTALA as a result of the Federal Civil Penalties Inflation Adjustment Act. The penalties have increased from $50,000 to $103,139 per violation for hospitals with 100 beds or more, and from $25,000 to $51,570 per violation for hospitals with less than 100 beds and for physicians themselves. Violations can also lead to exclusion from the Medicare program, and physicians can have their license revoked by the state medical board.
CMS and OIG recommend that hospitals provide EMTALA training for on-call physicians, and the Patient Protection and Affordable Care Act has specific provisions related to insurers and EMTALA-covered patients. Insurers cannot require a prior authorization for screening and stabilization services as defined under EMTALA. Hospitals must educate their physicians on their on-call responsibilities because the hospital can be fined for the on-call physicians’ failure to show up when requested.
In this session with expert speaker Sue Dill Calloway, RN, MSN, JD, you’ll learn about the proposed OIG’s changes to the regulations and CMPs that affect on-call physicians. Sue will explain how hospitals and critical access hospitals can ensure their compliance with the relevant federal regulations and interpretive guidelines on EMTALA and the on-call physician requirements. She will also discuss changes regarding the QIO handling of complaints, as two organizations now handle these.
Who Should Attend
Sue Dill Calloway, RN, MSN, JD, is the president of Patient Safety and Healthcare Consulting and Education company with a focus on medical-legal education especially Joint Commission and the CMS hospital CoPs regulatory compliance. She also lectures on legal, risk management and patient safety issues. She was a director for risk management and patient safety for five years for the Doctors Company. She was the...
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