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Resolving conflicts between EMTALA and managed care requirements.

F P Fedor1, A M Perez

  • 1Murphy Austin Adams Schoenfeld, LLP, Sacramento, California, USA. ffedor@murphyaustin.com

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|September 13, 2001
PubMed
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Managed care plans often require preauthorization for emergency care, risking hospital nonpayment or EMTALA violations. Hospitals can improve emergency department payment rates by challenging these requirements and ensuring a uniform standard of care.

Area of Science:

  • Healthcare Law
  • Emergency Medicine
  • Managed Care

Background:

  • The Emergency Medical Treatment and Active Labor Act (EMTALA) mandates emergency care regardless of ability to pay.
  • Managed care plans may impose preauthorization requirements for emergency services.
  • This creates a conflict between EMTALA obligations and managed care policies, potentially leading to nonpayment or legal violations for hospitals.

Purpose of the Study:

  • To analyze the conflict between EMTALA and managed care preauthorization requirements.
  • To identify strategies for hospitals to improve payment rates for emergency department (ED) care.
  • To advocate for a uniform standard of care in emergency treatment.

Main Methods:

  • Review of relevant legislation and managed care contracts.

Related Experiment Videos

  • Analysis of payment disputes and legal challenges related to emergency care.
  • Examination of hospital-provider negotiation strategies.

    • Main Results:

    • Preauthorization requirements by managed care plans pose a significant financial risk to hospitals.
    • Hospitals face potential EMTALA violations if authorization is denied or delayed for necessary emergency treatment.
    • Effective negotiation and legal challenges can lead to improved payment outcomes.

    Conclusions:

    • Hospitals should actively amend or challenge restrictive preauthorization requirements.
    • Insisting on a uniform standard of care for all ED patients is crucial.
    • Addressing these issues can enhance financial stability and ensure compliance with EMTALA.