Freestanding EDs that operate 24/7 and are located within 35 miles of an affiliated hospitalmay bill Medicare and receive full Part A reimbursement for services rendered. Such facilities are deemed off-campus emergency departments (OCEDs)
Full Answer
Can a freestanding emergency department accept Medicare patients?
Safety Today, the Centers for Medicare & Medicaid Services (CMS) issued critical guidance allowing licensed, independent freestanding emergency departments (IFEDs) in Colorado, Delaware, Rhode Island, and Texas to temporarily provide care to Medicare and Medicaid patients to address any surge.
What is a freestanding emergency department?
A freestanding emergency department (FSED) is a licensed facility that is structurally separate and distinct from a hospital and provides emergency care.
Should the state regulate freestanding emergency rooms?
For patients to better understand the capabilities and costs of freestanding EDs and to be able to choose the most appropriate site of emergency care, consistent state regulation of freestanding EDs is needed.
Do freestanding eds improve access to emergency care?
Overall, freestanding EDs have the potential to improve access to emergency care, but they may also increase health care costs.
What is a freestanding emergency department?
A freestanding emergency department (FSED) is a licensed facility that is structurally separate and distinct from a hospital and provides emergency care. There are two distinct types of FSEDs: a hospital outpatient department (HOPD), also referred to as an off-site hospital-based or satellite emergency department ...
What does MSE stand for in FSED?
ACEP believes that all FSEDs must follow the intent of the EMTALA statute and that all individuals arriving at a FSED should be provided an appropriate medical screening examination (MSE) by qualified medical personnel including ancillary services, to determine whether or not an emergency exists.
Does ACEP reimburse FSEDs?
ACEP encourages all states to have regulations regarding FSEDs that are developed in close relationship with the ACEP chapter in the state. ACEP believes that all FSEDs (both HOPDs and IFECs) that adhere to the standards set forth in this policy should be reimbursed by Medicare, Medicaid, and third-party payers.
Does CMS recognize IFECs as EDs?
Many states do not currently address licensing rules for IFECs. At this time, CMS does not recognize IFECs as EDs.
Does CMS allow Medicare for IFECs?
Therefore, CMS does not allow for Medicare or Medicaid payment for the technical component of services provided by IFECs. 1. The American College of Emergency Physicians (ACEP) believes that any FSED facility that presents itself as an ED, regardless of whether it is a HOPD or an IFEC, should:
Freestanding Emergency Departments (FrED): by the numbers
More than half of FrEDs (54.2%) are owned by a parent hospital (known as a “satellite”), 36.6% are independent, and 9.2% are not classifiable (*) (*). There are over 350 FrEDs across 30 states (*). And over 90% of FrEDs are located in urban as opposed to rural areas(*).
Do FrEDs Increase or Decrease Emergency Department Costs or Emergency Medicine Reimbursement?
One study analyzed the relationship between the number of FrEDs and overall spending for emergency care [*]. Researchers compared data from EDs in 495 different local markets in Arizona, Florida, North Carolina, and Texas. People in these markets are getting more FrEDs in their areas than others.
How does a freestanding ED affect the health care system?
Freestanding EDs are rapidly changing the landscape of acute care delivery. Overall, freestanding EDs have the potential to improve access to emergency care, but they may also increase health care costs. State regulations will directly affect freestanding EDs’ growth, patients’ access to them, and the quality of care they provide, and will determine whether their services are aligned with the public perception of emergency care. There is great variation in state requirements regarding the EDs’ licensing, operating, and staffing patterns. Certificate-of-need requirements can pose a significant barrier to overall growth of freestanding EDs but may be useful in discouraging their growth in areas that already have adequate access to emergency care. Variations in state policies may lead to an oversupply of freestanding EDs in states with few regulations, with fewer of the EDs operating in states with onerous regulations. As freestanding EDs seek to expand, policy makers can use these findings when considering future regulations concerning them.
What are freestanding EDs?
Many states had regulations requiring that freestanding EDs provide specific medical services; products; and technology such as equipment for monitoring, imaging, and treatment. For example, twelve of the thirty-two states with freestanding EDs required pediatric equipment to be available on site ( Exhibit 2 ).
What is EMTALA in hospitals?
EMTALA requires hospital-based EDs to screen all patients for emergency medical conditions, stabilize them, and either provide definitive emergency medical care or transfer them to another facility that is able to provide such care. EMTALA’s provisions apply only to hospitals that have entered into agreements with CMS, not to independent freestanding EDs. Of the thirty-two states with freestanding EDs, twenty-two (69 percent) had requirements for those EDs regarding emergency screening, stabilization, and transfers that mirrored those stipulated by EMTALA; nine (28 percent) of those states had no requirements for provision of these services at a freestanding ED ( Exhibit 2 ).
How far away from a hospital is an ED required in Nevada?
Most require a freestanding ED to be within 30–50 miles of a hospital. Nevada requires freestanding EDs to be located more than thirty miles by ground transportation from the nearest emergency department.
Where are EDs located?
Most EDs are located within hospitals, but there has been a rapid growth in the number of freestanding EDs in recent years. The concept of a freestanding ED was introduced in the 1970s as a way to provide emergency care in rural areas whose residents lacked access to an acute care hospital.
Which states require freestanding EDs?
For example, Mississippi required freestanding EDs to be at least ten miles from any licensed hospital, while Oregon prohibited the opening of a freestanding ED in a county with three or more hospitals that had an ED or in a city with a hospital that had an ED.
What are the operating requirements for EMTALA?
Operating requirements included regulations that mirror federal EMTALA requirements for medical screening and stabilization, transfer and transport agreements with other hospitals and emergency medical services, and required medical equipment.