Class 12 HAN 434

transferring

(transferring, receiving) hospital Responsibilites: -written request by the patient -signed certification by the physician

receiving

(transferring, receiving) hospital Responsibilities: -has space/qualified personnel -agreed to the transfer

patient registration

-as long as the process does not delay medical screening or treatment -the __ ___ processes may not discourage individuals from remaining for further evaluation

transaction account

-deposit or other account from which the owner makes payment or transfers

active labor

-determined by consideration of time factors --whether there is adequate time to effect a "Safe transfer" to another hospital before delivery

72 hours

time period for reporting violations -receiving hospitals must report a possible EMTALA violation within ___ ____

EMTALA

when a hospital is on diversion, it cannot be held to _____

pre termination

with EMTALA, there are NO ___ ____ appeal rights. -hospitals must either submit plan of corrective action or termination

pharmaceutical industry

the influence of the ___ ____ has been a major cause for concern. A study found that a number of academic institutions do not have clear guidelines for relationships between IRB's and industry

transfer

the movement (including the discharge) of an individual outside a hospital's facilities at the direction of any person employed by the hospital, but does not include such a movement of an individual who a) has been declared dead b) leaves the facility without the permission of any such person

triage

the process by which a quick determination is made as to how quickly and how extensively the ED's resources should be used to provide treatment to a patient [the ___ nurse is going to decide who needs to be seen first]

creditors

the red flag rules apply to financial institutions and ____ with covered accounts

prior authorization

can only seek once the hospital provides medical screening and initiates further examination and treatment required for stabilization

disclosure

certain professionals are required either by rules related to their professional organization to disclose an actual or potential conflicts of interest

exploit

conflicts of interest can also be defined as a situation in which an individual or corporation is in a position to ____ a professional or official capacity in some way for their personal or corporate benefit

admitted patient

continued treatment in an inpatient setting for further stabilization. the point when the EMTALA obligation under the law are discontinued

red flag rules

-require financial institutions and creditors to develop and implement written identity theft prevent programs provisions: must provide for the identification, detection, and response to patterns, practices, or specific activities known as "__ ___" that could indicate identity theft

self dealing

-the official is on both sides of the deal ex: an official who controls an organization causes it to enter into a transaction with the official or with another organization that benefits the official

hospital owned ambulances

-usually integrated with other EMS services, can transport patient to area hospitals when the intended receiving hospital notifies the ambulance the hospital is on diversion

hospital concerns

1) overcrowding in the ED 2) long delays for patients 3) local issues of uncompensated care 4) regulations and guidance is confusing 5) unsure how to apply the regulations

technical advisory group

EMTALA ___ ___ ___ (TAG) 1) review EMTALA regulations 2) Provide advice and recommendations 3) solicit comments and recommendations 4) disseminate information

patient anti dumping

EMTALA is known as the ___ ___ ___ law.

civil monetary penalties

Hospitals ___ ____ ___ per violation -not more than 25,000 if hosp has less than 100 beds -not more than 50,000 if hospital has more than 100 beds -hospital is terminated from the Medicare program (physicians also have ___ ___ __ and are terminated from the medicare medicaid programs)

contractions

NOT IN ACTIVE LABOR: defined as not having ____ and not covered under EMTALA

medical screening exam

Patient presents to the ED: 1) appropriate ____ ____ ____ aka Triage which includes vital signs and health history 2) provide further medical examination and treatment to stabilize the medical condition 3) if unable to stabilize, must provide an appropriate transfer to another medical facility

NCUA

RED FLAG RULES -most of these institutions are regulated by the federal bank regulatory agencies and the ____

investigative procedures

Task 1: Entrance Conference Task 2: Case Selection Methodology Task 3: Record Review Task 4: Interviews Task 5: Exit Conference Task 6: Professional Medical Review Task 7: Assessment of Compliance and Completion of the Deficiency Report

patient refusal

What if patient refuses examination, treatment, or transfer? The hospital must: -offer medical examination -explanation of risks/benefits -obtain refusal in writing

physician

Who can report EMTALA violations? 1) patient complaints 2) ____ complaints 3) EMS system complaints 4) routine site visits 5) newspaper articles

codes of ethics

___ _ ____ help to minimize problems with COI bc they can spell out the extent to which such conflicts should be avoided

dedicated emergency department

___ ___ ____: any department or facility of the hospital, whether situated on or off the main hospital campus -specifically licensed by the state as an ER or ED -is held out to the public as providing care for emergency med conditions without requiring an appointment -has provided, during its previous calendar year, emergency care or emergency services for at least one third of all its outpatient values

financial institutions

___ ___ are state or national bank or any other entity that holds a transaction account belonging to a consumer

non emergency

___ ___ such as preventative care services, suture removal

third party evaluations

____ ___ __ may be used as proof that transactions were fair

small physician practices

____ ___ ___ in addition to law firms are exempt from compliance if they do not use or report to crediting agencies (most ___ __ ___ know their patient's by face) RED FLAG RULES

hospital owned ambulances

____ ___ ___ is held to emtala while community ambulances are not

suture removal

a NON emergency a) screening exam by ED nurse -patient's history -exam of the sutures -determines wound is healing appropriately b) conclusion: no emergency condition exits -patient is discharged home

covered

a ___ account is also an account for which there is a foreseeable risk of identity theft

conflict of interest

a ____ _ ____ occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other.

covered account

a ____ ___ used mostly for personal, family, or household purposes and that involves multiple payments or transactions it includes credit card amounts, mortgage loans, automobile loans, cell phone accounts, checking/savings account

creditor

any entity that regularly extends, renews, or continues credit ex: finance companies, automobile dealers, mortgage brokers and etc

stabilize

determination is ultimately a matter of clinical judgment on the part of the medical professional assessing the patient 1) for emergency medical conditions--that no material deterioration of the patient's condition is likely to result from the transfer 2) for patients in active labor..the infant and the placenta have been delivered

revolving door

government workers or elected officials quitting public service to work for companies they used to regulate

violation

hospitals can be in ____ if they fail to: 1) comply with hospital policies and procedures that address the EMTALA provisions 2) report suspected inappropriate transfers 3) post required signs 4) maintain records for 5 yrs 5) maintain a list of on call physicians 6) maintain a central log on each individual that comes to the hospital seeking emergency services 7) provide appropriate medical screening 8) provide stabilizing treatment 9) provide examination or treatment without a delay in order to inquire about payment status 10) provide to appropriate transfer 11) provide whistleblower protections 12) meet receiving hospital responsibilities (nondiscrimination) 12 things.

diversion

hospitals only go on ____ when they are filled to capacity --it's rare that hospitals go to _____

law firm

in the US, a ___ ___ cannot represent a client if its interests conflict with those of another client even if they have separate lawyers within the firm

admitted

once a patient is stabilized, they can be ____, thus ending the EMTALA period

activities

red flag ____ 1) alerts, notifications, or warnings from a consumer reporting agency 2) suspicious docs 3) suspicious personally identifying info 4) unusual use of an covered account

board of directors

red flag rule: must be managed by the ___ __ __ or senior employees of the financial institution or creditor

EMTALA

requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage, or ability to pay, when a patient presents to an ER for attention to an emergency medical condition

resolution

some red flag ____: 1) photo ID 2) SSN check 3) bill hold 4) patient notification 5) law enforcement notification 6) handling medical records

community

the ambulance NOT COVERED UNDER EMTALA

three years

the appeal process can take up to ___ ___ to complete -medicare benefits are not paid to the hospital -bankruptcy usually closes the hospital before process is complete -negative publicity with termination is usually considered fatal itself

removal

the best way to handle conflict of interests is to avoid them entirely this is ____