Are hospitals required to obtain PCP approval prior to providing emergency services?
No. Federal law requires hospitals to screen and stabilize emergency patients before seeking prior authorization or inquiring about insurance status. After the patient is screened and stabilized, the emergency department may contact the PCP to discuss and coordinate additional, medically necessary services. PCCM utilization management guidelines abide by the “prudent layperson” definition of an emergency.
No. Federal law requires hospitals to screen and stabilize emergency patients before seeking prior authorization or inquiring about insurance status. After the patient is screened and stabilized, the emergency department may contact the PCP to discuss and coordinate additional, medically necessary services. PCCM utilization management guidelines abide by the “prudent layperson” definition of an emergency.
Related Questions
- Does CIRM require a Grantee to obtain prior CIRM approval of strategies to exploit CIRM-Funded Technology – whether by license, sale or other form of transfer?
- Do hospitals need to obtain consent to release information prior to calling in clinical information for concurrent review?
- Are hospitals required to obtain PCP approval prior to providing emergency services?
