Are your plans requiring pre-authorization for admission or transfer following the MSE? Hospitals are not permitted to comply according to CMS. Payors requiring secondary evaluation and approval of individuals with EMCs by insurer/payor-designated personnel as a condition for inpatient admission or transfer, including designation of transfer destination. 42 CFR 489.24(a)(1) requires that the MSE be … Read more
Can Payors Require Pre-authorization For ED Visits? Historically, the answer has been NO. You cannot even ask about the insurance provider before the MSE without risking citation, and especially if that results in the patient being delayed or not being seen at all. CMS has not backed off that position, stating: Section 1001 of the … Read more
In the preceding segment, CMS brought up the topic of “stability”, and they go on in this segment to make it clear that the situation with stability has never been based on “clinical stability” but upon the whether or not the patient was at risk to deteriorate from or during transfer or discharge. 42 CFR … Read more
The new healthcare reform law is causing rampant confusion on many levels, and that includes among payors, plans, employers, and hospital personnel similar to the push for HMO’s and Healthcare planning in the 1990’s. Because of the varied issues, CMS has issued a clarification on EMTALA — and as I predicted, EMTALA is not going … Read more
If a medical staff member reports suspected or alleged EMTALA violations, are they protected by the same Whistleblower provisions of EMTALA as hospital employees? The answer to that question is that they are, according to federal court ruling in Wisconsin in late November. In the case at hand, Dr. Kamal Muzaffar, sued Aurora Health Care … Read more
A new question came up today on whether Flu Shots in the Emergency Department trigger EMTALA. My “lawyeresque” answer is “No — except…” We actually have some guidance that appears relevant: The guideline for determining whether an area should be considered a “Dedicated Emergency Department” refers to the number of unscheduled presentations for emergency department … Read more
Steve Wilder — one of the featured presenters in our webinars — has announced a new training series for healthcare. While I am not involved in Steve’s work, I am in a good position to evaluate it and recommend him and his team on this issue: Sorensen, Wilder & Associates (SWA) is excited to share … Read more
CMS S&C: 14-02 Issued October 1, 2013 details the following functions that are “closed” and those that are to remain in operation during the current government “Shutdown”. NOT AFFECTED: CLIA survey and certification functions (provided through user fees) National background check programs (funded through separate appropriation process) CMS vendor contracts awarded prior to October 1, … Read more
The controversial CMS rule that terminates EMTALA if the patient is “Admitted” is a source of major contrary holdings by US federal courts. The plain language of the EMTALA law does not jibe with the CMS regulation, and a slight majority of federal courts have ruled that CMS lacked the authority to issue regulations that … Read more
Question: When an ambulance meets a helicopter at our helipad, they are on our property, so doesn’t that automatically trigger EMTALA? Answer: No Question: Shouldn’t our doctor go out and do a rapid assessment? Answer: Hell, NO! (Unless help was requested) REPRINT OF PRIOR ARTICLE FROM OUR ARCHIVES: Medlaw.com E-Bulletin September 15, 2006 I am … Read more