Resolving conflicts between EMTALA and managed care requirements.
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires a hospital to provide services to persons who come to the emergency department (ED) for emergency treatment without regard for their ability to pay. Yet some managed care plans require that the hospital obtain authorization before rendering emergency medical treatment, with the result that hospitals risk either nonpayment for services or violation of EMTALA. Hospitals can improve their payment rates for ED care by amending or challenging preauthorization requirements and insisting that plans apply a uniform standard of care to treatment of ED patients.
Fedor
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Murphy Austin Adams Schoenfeld, LLP, Sacramento, California, USA. ffedor@murphyaustin.com
Perez
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D003220:Conflict, Psychological; D003284:Contract Services / Q000191:economics / Q000331:legislation & jurisprudence; D004636:Emergency Service, Hospital / Q000191:economics / Q000331:legislation & jurisprudence*; D005377:Financial Management, Hospital / Q000331:legislation & jurisprudence*; D020793:Gatekeeping / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D020380:Needs Assessment; D010360:Patient Transfer / Q000331:legislation & jurisprudence*; D014481:United States