Description:-

• Why is there so much non-emergent care in the ED?
• Can the ED turn away urgent conditions and only treat true emergencies?
• How are hospitals EDs coping with increasing volumes of uninsured that require non-emergent care?
• How does EMTALA (Emergency Medical Treatment and Labor Act) fit into providing non-emergent care?
• What is the difference between emergent, urgent and clinical care in the ED?
• What impact does the lack of primary care services have on a hospital’s ED?
• What steps can hospitals take to reduce non-emergent care in the ED?
• How do Medicare and other third-party payers react to non-emergent care in the ED?
• What about provider-based Urgent Care Centers?
• What about freestanding EDs?

Objectives of the session: 

• To review the levels and types of services in the ED.
• To differentiate between emergent, urgent and clinical levels of services.
• To understand the reasons for increasing volumes of urgent and clinical level services in the ED.
• To appreciate how EMTALA rules and requirements dovetail with non-emergent levels of care.
• To understand the increasing needs for fast-tracks and establishment of urgent-care clinics.
• To understand pressures on Medicare and other third-party payers to create special coding, billing and reimbursement processes for non-emergent care in hospitals’ EDs.
• To appreciate surgical services and the associated coding and billing for such services.
• To understand when Urgent Care Clinics are EDs
• To appreciate the role of freestanding EDs
• To examine several case studies illustrating the challenges for non-emergent care in hospitals’ EDs.

Agenda of the Session: 

• Overview of ED Services
  • Emergency Care Including Trauma Services
  • Urgent Care
  • Clinical Services Provided in the ED
  • Freestanding EDs
• Growth in Volume of Non-emergent Care
  • Underinsured
  • Uninsured
  • Lack of Accessible Primary Care
• EMTALA Considerations
  • EMTALA Obligations
  • MSE – Medical Screening Examination
  • Care vs. Stabilize and Transfer
  • Qualifying Nurses for Performing MSEs
  • Sending Patients to Clinic for Services
• Hospital Organizational Structuring
  • Fast-Tracks inside EDs
  • Urgent Care Clinics
  • Provider-Based Walk-In Clinics
  • Compliance Concerns
  • Opt-Out Physicians and Practitioners
• Coding and Billing Considerations
  • Use of Emergency Level Codes
  • Use of Clinic Level Codes
  • Chargemaster Development for Urgent and Clinic Care
• Predicting the Future
  • Medicare Directions
  • Private Third-Party Payer Approaches
  • Payment System Changes
• Special Case Studies  
• Sources for Further Information.

Suggested Attendees: 

ED Personnel, Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Utilization Review Personnel, Internal Audit Staff, Financial Analysts, Compliance Personnel, Physicians, Non-Physician Practitioners and Other Interested Personnel.