HospitalInspections.org

Based on policy review, document review, medical record review and interview, it was determined the hospital failed to ensure the Emergency Department (ED) provided an appropriate Medical Screening Exam (MSE) to determine if an emergency situation existed prior to seeking and obtaining payment for 1 of 20 (Patient #7) patients reviewed.

Refer to findings in deficiency V 2408.

Based on policy review, document review, medical record review and interview, it was determined the hospital sought and obtained payment as a condition for provision of services prior to performing a Medical Screening Examination (MSE) for 1 of 20 (Patient #7) patients reviewed.

The findings included:

1. Review of the hospital's "Emergency Department Registration" policy revealed "Discussion of patient's financial liability including prior authorization (co-payment, deductibles, past due balances) will not occur until medical screening examination and stabilization ( if emergency) have been completed... Medical Screening may not be delayed in order to: a. Inquire about the individual's ability to pay for services... b. advise the patient that he/she may be responsible for payment of services rendered..."

2. Review of the hospital's "Emergency Department Triage" policy revealed, "Patients with non- participating insurance providers and patients who do not have insurance will be informed there is an Emergency Department fee at the time of discharge. Payment is not required as a condition of treatment."

3. Review of the hospital's "Inpatient/Outpatient Conditions of Admission and Consent to Medical Treatment" form revealed, "1. ASSIGNMENT OF INSURANCE BENEFITS / PROMISE TO PAY: I hereby assign and authorize payment directly to the Facility... I understand that I am responsible for any charges not covered by my insurance company...I understand that I am obligated to pay the account of the Facility in accordance with the regular rates and terms of the facility... The undersigned certifies that he/she has read the foregoing, understands it, accepts its terms, has received a copy of it and is the patient or duly authorized by the patient as their agent to execute the above."

4. Medical record review for Patient #7 documented the patient presented to the emergency department (ED) at 12:18 AM on 2/25/12. Triage began at 12:42 AM for complaints of several episodes of nausea, vomiting and diarrhea since 1:00 PM yesterday. The patient stated there may have been some blood in the emesis that was bright and dark red and that he had recently returned from trip to Colorado. Laboratory and X-rays performed documented the patient had a BUN (blood urea nitrogen) level of 24 (normal 7-18), Creatinine 1.4 (normal 0.6-1.4), 40 ketones in his urine (negative is normal), WBC (white blood count) 19.85 (normal 4.6-10.20) and the CAT scan impression: "mild to moderate wall thickening in right colon. Consistent with colitis from infectious versus other inflammatory etiology." Review of the Nurse Documentation form documented at 5:50 AM, "states nausea has improved." At 7:50 AM, the nurse documented, "Pt tolerating sips of water without n/v [nausea vomiting]." The Physician's Assistant documented the patient was discharged home in improved condition at 7:52 AM.

Patient #7 signed by initialing the Inpatient/Outpatient Conditions of Admission and Consent to Medical Treatment form on 2/25/12 at 12:50 AM. The Emergency Physician Record dated 2/25/12 documented the MSE was initiated at 3:40 AM.

5. On 4/4/12 at 12:00 PM, the Emergency Department Director provided the surveyors with a copy of a Customer Transaction receipt. The receipt documented the name of Patient #7 and an amount paid of $100.00 through a Visa card in the name of the person (Significant other) accompanying Patient #7. The date and time of the payment was 2/25/12 at 2:48 AM Central Time.

6. In a telephone interview on 4/3/12 at 4:30 PM, Patient #7 stated, "...Went back to a room... Clerk came in and said, 'Normally before seeing the doctor we ask for a $200.00 deposit'... [Significant other's name] told them to take $100.00 out of her debit card."

7. In an interview on 4/4/12 at 12:50 PM in the Account Access Managers office, the Account Access Manager verified the money had been collected at 12:48 AM and the clerk who collected the money is no longer employed at the hospital as she had moved out of town.