Medicare Compliance & Reimbursement

On May 18, Missouri state legislators approved a law barring insurers from denying emergency department claims based solely on the final diagnosis that the physician assigns to the visit. This move is intended to help those in the state face fewer denials.

The legislation defines "emergency medical condition" as "the sudden and, at the time, unexpected onset of a health condition that manifests itself by symptoms of sufficient severity, regardless of the final diagnosis that is given, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that immediate medical care is required..."

The bolded portion of the text above is indeed bolded in the bill, demonstrating lawmakers' commitment to fixing the issue going forward. The insurer would have to look at the symptoms that prompted the ED visit, rather than the final diagnosis, to determine whether to pay the claim.

At press time, the bill was awaiting the governor's signature.

Reference: To read the legislation, visit https://legiscan.com/MO/text/SB982/id/1715551.