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News You Can Use: EMTALA Creates Advisory Group to Develop Rules

Why your EMTALA burdens could get lighter

The Emergency Medical Treatment and Labor Act (EMTALA) may be putting undue strains on your facility. To help you, CMS announced March 14 the appointment of a new technical advisory group (TAG) that will review regulations affecting hospital and physician responsibilities under the act. 
The TAG, which was required by the Medicare Modernization Act, should assist in developing "rules that will protect individual rights while minimizing unnecessary burdens on healthcare providers," CMS says. Among the 19 members of the advisory group are CMS Administrator Mark McClellan and the HHS Inspector General Dan Levinson.

EMTALA requires hospitals with emergency departments to provide an appropriate medical screening when a person comes to the hospital and requests treatment for a medical condition. If a physician detects an emergency medical condition, the hospital must either stabilize the individual or transfer him to another facility. To read about the meeting in the Federal Register, go online to .
How a new chiropractic demo could help your facility

Getting paid for x-rays, MRIs and CT scans ordered by chiropractors could be a done deal soon. Facilities based in Maine, New Mexico, Iowa, Illinois and Virginia are already gearing up for a two-year demonstration project beginning April 1, 2005, which will allow them to accept chiropractic referrals and be reimbursed by Medicare for radiology services.
The Medicare Modernization Act created the demo to evaluate whether beneficiaries who participate would use fewer Medicare-covered services than those not participating. The Department of Health and Human Services must report to Congress on the outcome no later than one year after the demonstration concludes. To read the related Medlearn Matters Article (SE0522), go online to .
Here's how to catch up with the new appeals process

CMS is pushing forward with its plan to overhaul the claims appeal system by the end of 2005.

Update: The agency has issued an interim final rule that responds to public comments about changes to the appeal procedures. The rule also explains how the new process will be implemented, CMS said.
Got questions? You're not alone. Providers, suppliers, beneficiary advocacy groups and administrative law judges (ALJs) vented a variety of concerns to CMS.

Here's a look at some issues the agency addresses in the rule:

protections for unrepresented beneficiaries

deadlines for filing appeals and time frames for decision- making

reconsiderations

evidentiary requirements

the role of the ALJs

dismissals and remands of appeals

distinctions between reopenings and appeals.

The regulations go into effect May 1, 2005. The catch: CMS says that due to the "wide span of applicability of these rules and the complex, intertwined nature of the affected appeal procedures," [...]

- Published on 2005-04-13