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[Editor’s note: Kathy Pajor, director of patient access services for St. Vincent’s Medical Center in Bridgeport, CN, asked Hospital Access Management for clarification on the federal Emergency Medical and Treatment and Active Labor Act (EMTALA) requirements. Here is her question, with some guidance provided by Loren Ratner, an attorney specializing in health care matters with Nixon Peabody LLP in Garden City, NY.]
"I’ve read many articles about point of service collections in the emergency department. Some hospitals collect payment after discharge, some after the physician completes the initial medical screening. Others ask for copays during the registration process. Would a hospital emergency department (ED) be in violation of EMTALA if the registrar asks for copayments at the time of registration, before the physician completes the initial medical screening?"
Although hospital emergency departments are not specifically prohibited from requesting copayments from patients during registration prior to medical screening and treatment, caution must be exercised to ensure that the provision of care is not delayed and that patients are not discouraged from obtaining such care due to the request. Hospitals may not condition the provision of the medical screening examination or necessary stabilizing treatment upon payment by the patient.
A hospital ED clearly would be in violation of EMTALA if provision of a medical screening examination and stabilizing treatment were conditioned upon receipt of a copayment from a patient. In their jointly issued Special Advisory Bulletin on the Patient Anti-Dumping Statute, the Office of the Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS) addressed the issue of the registration process employed in EDs in light of EMTALA’s mandates.(64 Fed Reg 61,353, from 1999). The Special Advisory Bulletin provides that while it is acceptable to ask for general registration information prior to the medical screening exam, conditioning the screening and treatment upon payment of the copay "could unduly deter the individual from remaining at the hospital to receive care to which he or she is entitled and which the hospital is obligated to provide regardless of ability to pay, and could cause unnecessary delay."
While hospitals may not condition screening and treatment upon receipt of copayments, they are permitted to request financial information from patients, as long as care is not delayed due to the inquiry about the patient’s insurance status or method of payment. Hospitals should ensure that their ED registration processes do not discourage individuals from remaining for screening and treatment. A reasonable registration process may include asking whether an individual is insured, and if so what that insurance is, along with other relevant information, such as demographic information, and emergency contact information. The OIG and CMS have suggested that hospitals defer discussion of a patient’s financial responsibility or obtaining a patient’s agreement to pay for services until after beginning stabilizing treatment.
So while hospitals are not specifically prohibited from requesting copayments from patients prior to the provision of screening and stabilization, each hospital must carefully evaluate its registration procedures, to ensure that such requests do not discourage patients from remaining for care. The most prudent course would be to defer requests of copayments until he medical screening examination has been completed and until necessary stabilizing treatment is under way.