EMTALA and the On-Call Physician: Proposed Changes by CMS/OIG

EMTALA and the On-Call Physician, and Proposed Changes

Event Information
Product Format
Prerecorded Event
Presenter(s)
Sue Dill Calloway, RN, MSN, JD
Conference Date
Tue, Mar 20, 2018
Length
120 minutes
Product Description

Prepare On-Call Physicians for CMS Proposed Changes and Compliance with EMTALA


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.

Session Highlights

With this session, you will learn that:

  • CMS has an EMTALA CoP that lists the responsibilities of on-call physicians
  • Hospitals must have specific names of physicians on call and not the group practice’s name
  • The hospital must maintain a list of physicians who are on call to evaluate the emergency department patients
  • Both CMS and OIG recommend that all hospitals provide on-call physician with education on their on-call responsibilities under EMTALA
  • EMTALA is a top problematic standard for hospitals from CMS
  • The EMTALA has now more than doubled

Session Agenda

This session will cover:

  • Who the players are
  • CMS website
  • OIG-proposed changes to on-call physicians
  • CMS deficiency memo and EMTALA: The number one problematic standard
  • OIG-proposed changes affecting on-call physicians
  • QIO to determine medical standard of care
  • 2 QIOs BFCC for investigating complaints
  • Payment for on-call coverage
  • Shared and community call plans
  • In-patient prospective payment system (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 simultaneously on-call physicians
  • Responding within a reasonable time
  • Policy and procedures
  • Frequency of on-call physicians
  • Exemption for senior MS or recognition of years of service
  • Maintaining on-call list
    • 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
    • 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?
  • Physician education
  • Certification of false labor requirement
  • Practices that have gotten physicians in trouble

Who Should Attend

  • CEOs
  • COOs
  • Emergency department managers
  • Emergency medicine physicians
  • Emergency department nurses
  • OB managers and nurses
  • Behavioral health directors and staff
  • Psychiatrists
  • Nurse supervisors
  • Compliance officers
  • Legal counsel
  • Risk managers
  • Chief nursing officers (CNOs)
  • Chief medical officers (CMOs)
  • Consumer advocates
  • Patient safety officers
  • Compliance officers
  • Regulatory affairs directors
  • Directors of hospital-based ambulances
  • ED nurse educators
  • Nurse educators
  • Medical staff directors
  • Hospital attorneys
  • Nurse educators
  • Nurse managers
  • Anyone involved in ensuring compliance with the EMTALA law

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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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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