EMTALA and the On Call Physician

Event Information
Product Format
Prerecorded Event
Sue Dill Calloway, RN, MSN, JD
90 minutes
Product Description

Federal Regulations and Guidelines on EMTALA and the On-Call Physician Requirements

According to CMS, the Emergency Medical Treatment and Labor Act (EMTALA) deficiencies are considered as the number one problematic standard for hospitals. CMS has started issuing deficiency memos, and many hospitals were surprised to see EMTALA deficiencies as the top deficiency where many involved the on-call physician issue. The November 2014 deficiency report found 1725 EMTALA deficiencies, out of which 85 were related to on call physician issues. In this program, expert speaker Sue Dill Calloway will discuss the proposed OIG changes which affect on-call physicians. She will also shed light on 2015 changes regarding the QIO handling of complaints – as two organizations will now be handling them.

Every hospital that has an emergency department and accepts Medicare or Medicaid reimbursements must follow the federal law and CMS interpretive guidelines on EMTALA, and this covers critical access hospitals. Penalties are attached for both the hospital and the physician for violating this law including up to $50,000 fines and exclusion from the Medicare program. Additionally, physicians can be fined and excluded from participating in any federal program and their license revoked by the state medical board. The Center for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) suggest that hospitals provide EMTALA on call training for their physicians who are on call.

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.

Sue will include the EMTALA regulations concerning On-Call Physicians. It is important that every hospital and critical access hospital be in compliance with the federal regulations and interpretive guidelines on EMTALA and the On-Call Physician requirements. What has your hospital 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. This webinar will cover the following issues;

  • Who are the players?
  • Review of CMS website
  • Discussion on CMS deficiency memo and why EMTALA is the number one problematic standard
  • OIG proposed changes affecting on-call physicians
  • Review of QIO for determining medical standard of care
  • 2 QIOs BFCC for investigating complaints
  • Insights on payment for on-call coverage
  • Discussion on shared and community call plans
  • Inpatients PPS EMTALA Changes
  • Review of OIG bulletins on on-call doctors
  • Overview of OIG advisory bulletins on paying on call physicians
  • EMTALA Guidance Memos— an insight
  • Where to find the EMTALA Law
  • Insights on essentials of Provider Agreements and on-call physicians Review of CMS Interpretive Guidelines
  • Review of OIG CPG for Hospitals Recommends on-call physician education
  • Discussion on on-call list of physicians, relevant factors test
  • CMS Memo on On-Call Requirements and Simultaneously On-Call
  • Responding within a reasonable time
  • Policy and procedures
  • Insights on frequency of on-call physicians
  • Insights on exemption for senior MS or recognition of years of service
  • Maintaining on-call list—can a physician 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,
    • If physician treats a patient while on call for the ED must they treat the patient again?
    • If the physician is on call must he treat the patient if patient was discharged for failure to pay the bill?
  • The importance of physician education
  • Learn about the certification of false labor requirement
  • Identify the practices that have gotten physicians in trouble

Session Objectives:

  • Understand the CMS EMTALA CoP which lists the responsibilities of physicians on call
  • Learn why hospitals must have specific names of physicians on call and not the group practice’s name
  • Understand why the hospital must maintain a list of physicians who are on call to evaluate emergency department physicians
  • Review of CMS and OIG’s recommendation that all hospitals need to provide on-call physician with education on their on-call responsibilities under EMTALA
  • Insights on why EMTALA is considered as the number one problematic standard from CMS

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, compliance officers, legal counsel, risk managers, chief nursing officer

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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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