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Based on review of hospital documents, medical records and interviews with hospital staff, the hospital failed to enforce policies and procedures to ensure compliance with the requirements of 42 CFR 489.24. The hospital failed to enforce its policy and procedure concerning delay in examination or treatment.

Findings:

Review of a Mercy Hospital Oklahoma City, policy and procedure, entitled, "Obtaining Financial Information in the Emergency Room", documented, " ...3. Patients will not be registered and no financial information will be obtained until the patient has been assigned an ER physician and the patient has been provided a medical screening exam...."

Record #1 contained documentation financial information was discussed with the patient prior to the emergency room (ER) physician being assigned and a medical screening exam being completed. This was confirmed by Staff B during medical record review on the afternoon of 04/07/2015.

Based on review of hospital documents, medical record review and interviews with hospital staff, the hospital failed to provide an appropriate medical screening examination (MSE) prior to inquiring about the individual's method of payment or insurance status. This occurred in one (Record #1) of 30 medical records reviewed.

Findings:

Review of a Mercy Hospital Oklahoma City, policy and procedure, entitled, "Obtaining Financial Information in the Emergency Room", documented, "...3. Patients will not be registered and no financial information will be obtained until the patient has been assigned an ER physician and the patient has been provided a medical screening exam..."

A tour of the emergency department (ED or ER) was conducted on the afternoon of April 06, 2015.

Staff I, identified as a ER registration clerk was asked to explain the ER registration process to the surveyors.

Staff I stated patients are not registered and insurance information is not obtained until after a physician has been assigned to the patient. Staff I was asked how the registration clerks were made aware of when to register a patient. Staff I stated on the computer screen a "red bell' will populate in a field next to the patients name. Staff I went on to explain that the red bell indicates that the ER physician had performed the MSE.

Medical records were reviewed on the afternoon of April 07, 2015, with Staff B, C and CC.

Record #1 documented, the patient presented to the emergency room (ER) at 00:45 am on 03/16/2015 complaining his left eye feels like it is "burning". At 00:46 am the patient was triaged at a level 4- less urgent, based on the Emergency Severity Index (ESI). An assessment of the patient was completed by the RN at 01:38 am.

Record #1, documented the ER registration clerk, discussed financial responsibility with the patient on 03/16/2015 at 01:38 am. The registration clerk documented in the summary, " MULTI INSURANCE NO COPAY". The ER provider was not assigned to the patient until 01:40 am. This was confirmed by Staff B.