Every hospital that has an emergency department and accepts Medicare or Medicaid reimbursement must follow the federal law and the Centers for Medicare and Medicaid Services (CMS) interpretive guidelines on the Emergency Medical Treatment and Labor Act (EMTALA). This includes critical access hospitals. The Patient Protection and Affordable Care Act have specific provisions related to insurers and EMTALA-covered patients. Insurers cannot require a prior authorization for screening and stabilization services as defined under EMTALA.
However, did you know that EMTALA deficiencies were the number one problematic standard for hospitals from CMS? CMS has started issuing quarterly deficiency memos and many hospitals were surprised to see that EMTALA deficiencies were a top deficiency and many involved the on-call physician issue. The current CMS deficiency report found over 3,687 EMTALA deficiencies. There were 173 related to on-call physician issues.
Stiff penalties attach for both hospitals and the physicians for violating this law. However, did you know that the penalty has more than doubled? This includes up to a $104,826 fine for hospitals with 100 or more beds and exclusion from the Medicare program. Physicians can be fined and excluded from participating in any federal program and their license revoked by the state medical board.
It is essential that every hospital and critical access hospital is in compliance with the federal regulations and interpretive guidelines on EMTALA and the on-call physician requirements. What has your hospital done to educate your physicians on their on-call responsibilities? The hospital can be fined for the on-call physicians’ failure to show up when requested. The CMS and the Office of Inspector General (OIG) suggest that hospitals provide EMTALA on-call training for their physicians who are on call.
Join this session, where regulatory compliance expert Sue Dill Calloway, RN, MSN, JD, will cover the EMTALA regulations concerning on-call physicians. Sue will discuss the proposed OIG changes that affect on-call physicians. This session will discuss changes regarding the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) handling of complaints as two organizations will now be handling these. The session will further discuss the proposed changes to the on-call system from the OIG.
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Who Should Attend
Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.
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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