tci Medicare Compliance & Reimbursement - 2016 Issue 19

EMTALA Coding Case Study

Sometimes, the EMTALA regulation butts up against billing and coding rules, said compliance expert Duane C. Abbey, PhDin his recentAudioEducatorpresentation. Take the hypothetical case of “Sara’s Stuffy Nose.” Sara is a Medicare patient who woke up with a stuffy nose. She called her physician this morning, but the answering machine at the clinic indicated that the doctor was out of town and, if there were any problems, she should simply go to the emergency department at Apex Medical Center. At the ED, the triage nurse determined that while Sara has a stuffy nose, it probably is...

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