Title: ACEP // EMTALA and Prudent Layperson Standard FAQ
Headings: EMTALA and Prudent Layperson Standard FAQ
EMTALA and Prudent Layperson Standard FAQ
Content: Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.” Answer
According to CMS, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) in 1986 “to ensure public access to emergency services regardless of ability to pay’. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.” How does EMTALA impact coding, billing and reimbursement? Recommendations
Answer
As outlined above, EMTALA obligates Medicare participating hospitals to provide a medical screening examination when a patient presents to the emergency department for examination or treatment for an emergency medical condition (EMC). Until the medical screening examination is provided, hospitals may not query the patient about insurance or payment.