ED Coding and Reimbursement Alert

Question: Are our ED physicians permitted to discuss advance beneficiary notices (ABNs) with ED patients, or does that conflict with EMTALA (Emergency Medical Treatment and Labor Act) regulations?

Ohio Subscriber

Answer: It is a common misconception that discussing ABNs with ED patients violates patient anti-dumping laws.
 
While EMTALA requires that physicians screen and stabilize patients prior to inquiring about insurance coverage, the policy doesn't bar payment questions altogether, as long as asking such questions does not delay treatment or create an -economic coercion- that causes the patient to leave the ED.
 
After the physician completes screening and stabilization of the emergency patient, he has met the EMTALA requirements and can then ask the patient about payment for noncovered services.
 
CMS states: -Even when a beneficiary does not appear to have a life-threatening condition, rather, he or she is seeking primary-care services at an ER, an ABN should not be given to the beneficiary in any case in which EMTALA applies until the hospital has met its obligations under EMTALA.-
 
So from an EMTALA perspective, once you address the patient's emergency medical condition, you can consider an ABN.
 
Warning: CMS policy prohibits giving an ABN to a patient who is -under duress,- including patients who need ED services before stabilization.
 
Medicare Transmittal AB-02-114 states, -physicians and suppliers may not use ABNs to shift financial liability to beneficiaries in emergency care situations.-