ED Coding and Reimbursement Alert

Congress has $250 million set aside  to pay for your services

You can receive direct payments for some or all of your emergency healthcare costs and related inpatient, outpatient and ambulance services provided to undocumented aliens.

The Medicare Modernization Act (MMA) section 1011, titled "Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens," provides funding for physicians, state-licensed ambulance service providers, and Medicare participating hospitals, including critical access hospitals, from fiscal years 2005 to 2008, according to a May 9 CMS final policy notice update.

You can receive payments under section 1011 only for services not otherwise reimbursed during the given fiscal year. The funding applies to emergency services provided to undocumented aliens, aliens paroled into the country at a U.S. port of entry to receive eligible services, and Mexican citizens permitted to enter the United States for 72 hours.

Exceptions: Federally Qualified Health Centers and mid-level practitioners, including nurse practitioners, physician assistants, and clinical nurse specialists, cannot receive this funding. Payment starts when the hospital's Emergency Medical Treatment and Labor Act (EMTALA) obligation begins and continues until the patient is stabilized.

Physician services payments also cease when the patient stabilizes. Section 1011 doesn't provide payment for physicians' follow-up care for patients no longer receiving hospital services. 

To read the final policy notice, go online to http://www.cms.hhs.gov/providers/section1011/cms10130.pdf.