EMTALA FAQs
Who decides if the on-call specialist has to come in to see a patient?
The Emergency Room physician who has eyes on the patient EMTALA places the decision power with the physician with eyes on the patient. The response is not negotiable or debatable.
If your Hospital has “specialized capabilities” does your Emergency Department have to accept a transfer from a hospital that does not have the capabilities?
Yes, and depends. EMTALA requires any hospital with specialized capabilities greater than those of the sending hospital to accept all such patients in transfer, regardless of their means or ability to pay. The on-call physician is deemed to be within the capabilities of the hospital, and therefore, must accept unless there literally is not one more space to put the patient, or some other reason exists, such as non-functional equipment, that makes it impossible to deliver the needed service.
Can you put a “group or practice” name on the call schedule to show who is on-call?
EG: Cardiology: Smithfield Cardio Associates – No. CMS requires that individual physician names and direct contact information be available to specifically identify and provide contact information for the individual physician actually on call. Changes in the list must be updated PRIOR to a request for an on-call physician is placed.
Can your “admitting” department talk to the patient about if they have insurance or have a co-payment before being seen by an Emergency Room Physician?
No. EMTALA requires services to be rendered regardless of means or ability to pay. Where evaluation or stabilizing care, including surgery, is not complete, EMTALA prohibits seeking advance approval from insurance companies or plans. This rule, however, does not require the payer to make payment for the services. Hospital cannot request payment or co-pays until after an appropriate medical screening exam (MSE) is done and the emergency medical condition (EMC) is stabilized.
Can you evaluate an emergent patient who is under the age of 18 without consent?
Yes. A medical screening examination and any medical care necessary and likely to prevent imminent and significant harm to the pediatric patient with an emergency medical condition should not be withheld or delayed because of problems obtaining consent.
Can you tell a patient in the parking lot of your hospital that is suspected to have EBOLA that they must go to an EBOLA approved treatment facility before being evaluated?
No. Every hospital, including Critical Access Hospitals, with a dedicated emergency department, must conduct an appropriate medical screening examination on all patients coming to the ED. This includes patients suspected of having been exposed to Ebola. All EDs are expected to be able to apply appropriate Ebola screening. And if necessary to isolate and notify state agency.
Can you use Telemedicine to evaluate an Emergent patient?
Depends. The Center for Medicare & Medicaid Services welcomes the use of Telemedicine by Critical Access Hospitals: Telemedicine has great potential to expand the availability of specialty care services, including emergency medicine services, to rural populations. However, misconceptions about Critical Access Hospitals Condition of Participation and EMTALA requirements may cause unnecessary concerns about, or create barriers to, using telemedicine. The Critical Access Hospitals Emergency Services Condition of Participation does not require a physician to appear on-site whenever an individual comes to the emergency department.
If your Emergency Department is on diversion for Neurology, and a patient shows up at your facility with a possible Stroke can you immediately transport them without an evaluation to another facility?
No. EMTALA requires physicians to render care within their privileges, not their scope of usual practice. The physician specialist must come in and justify in writing any transfers and effect the transfer. If beyond the privileges of the physician, CMS expects the physician to come in, evaluate, and arrange transfer if appropriate services are not available.
If you are the on-call physician do you have to evaluate an emergent patient that you have a restraining order against?
Yes. I am aware of at least one case where a patient had assaulted several hospital personnel and the hospital obtained a restraining order against the patient. However, because federal law supersedes state law and despite the restraining order, this patient had to receive care anytime he presented to the ED. So, whether they are discharged from your practice or a patient who owes you thousands of dollars, they are still entitled to your services when you are on-call for the ED.
If you are on-call at two hospitals can you ask that the patient be transferred to the facility that you are currently working at?
No. EMTALA requires all care to be rendered in the hospital where the patient presents. The only circumstances where the request to transfer would be valid would be if the needs of the patient could not be met in a timely fashion where the patient presented, and the requested transfer would allow more timely intervention for patient safety and response of the on-call physician was not possible (i.e. currently involved in surgery).
