EMTALA and the On Call Physician and Proposed Changes

Event Information
Product Format
Prerecorded Event
Presenter(s)
Sue Dill Calloway, RN, MSN, JD
Length
90 minutes
Product Description

How OIG’s Proposed Changes to the EMTALA Guidelines Will Affect On-Call Physicians and the Hospitals Where They Work.

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.

Session Highlights

  • Why, according to CMS, EMTALA is a top problematic standard for hospitals
  • How hospitals can provide on-call physicians with education on their responsibilities under EMTALA, according to CMS and OIG recommendations
  • The responsibilities of on-call physicians as listed in the CMS EMTALA Conditions of Participation (CoP)
  • Why hospitals are required to have specific names of physicians on call and not the group practice’s name
  • How hospitals must maintain a list of physicians who are on call in order to properly evaluate emergency department physicians

Agenda Details

  • OIG proposed changes to the on-call system
  • Who the players are
  • CMS deficiency memo and why EMTALA is the number one problematic standard
  • OIG proposed changes affecting on-call physicians
  • QIO standard for determining medical standard of care
  • BFCC-QIO process for investigating complaints
  • Payment for on-call coverage
  • Shared and community call plans
  • Inpatient PPS EMTALA changes
  • OIG bulletins on on-call doctors
  • OIG advisory bulletins on paying on-call physicians
  • EMTALA Guidance Memos
  • Where to find the EMTALA law
  • Essentials of provider agreements and on-call physicians
  • CMS Interpretive Guidelines
  • OIG CPG for Hospitals recommends on-call physician education
  • On-call list of physicians
  • Relevant factors test
  • CMS Memo on on-call requirements
  • CMS Memo on being simultaneously on-call
  • Responding within a reasonable time
  • Policy and procedures
  • Frequency of serving as on-call physician
  • Exemption for senior MS or recognition of years of service
  • Maintaining on-call list and whether a physician can refuse to come to the ED
  • What to do during no coverage periods
  • Response time
  • Response of non-physicians
  • Certificate to transfer
  • Follow-up care, including whether an on-call physician who treats a patient in the ED must treat the patient again later
  • Whether an on-call physician must treat a patient discharged for failure to pay the bill
  • Physician education
  • Certification of false labor requirement
  • Practices that have gotten physicians in trouble
  • CMS website resources

Who Should Attend

  • CEOs
  • Emergency department managers
  • Emergency medicine physicians
  • Emergency department nurses
  • OB managers and nurses
  • Behavioral health director and staff
  • Psychiatrists
  • Nurse supervisors
  • Nurse managers
  • Compliance officers
  • Legal counsel
  • Risk managers
  • Chief nursing officer (CNO)
  • Chief medical officer (CMO)
  • Consumer advocates
  • Patient safety officer
  • Compliance officer
  • Regulatory affairs director
  • Director of hospital-based ambulances
  • ED nurse educator
  • Nurse educators
  • Medical staff director
  • Hospital attorney

Order Below or Call 1-866-458-2965 Today

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1-866-458-2965

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About Our Speaker

Sue Dill Calloway - Hospital Coding Expert


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...   More Info
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