Integrity Standards Handbook - Penrose-St. Francis

obtain financial or demographic information from the patient. Centura’s healthcare facilities may transfer a patient to another facility at the patient’s or treatingphysician’s request or if the health care facility does not have the ability totreat the emergency and appropriate care is available at another facility.Q:A:Q:If we register an emergency room patient before we performa medical screening examination and stabilization procedures,are we in violation of EMTALA?You may register the patient first only if the process does not delay themedical screening examination and stabilization OR include questionsabout the patient’s ability to pay. It is okay to ask the patient if he/shehas insurance and the name of the carrier. Any further questions aboutfinancial information must wait until after the medical screeningexamination. Employees trained in EMTALA regulations and hospitalprocedures should register the patient.Fraud, Abuse or False Claims/Billing and Coding AccuracyFederal and state laws and regulations govern third party billing for our insuredpatients, residents, and other individuals in our care. You and Centura can beprosecuted for filing inaccurate or fraudulent claims or statements, a practicethat carries extremely large civil fines and/or criminal penalties. Centura doesnot condone and will not tolerate submission of false, fraudulent, inaccurate,incomplete or fictitious claims for payment or reimbursement. If youare responsible for medical records, billing and/or coding and/or are an individualresponsible for creating a charge as applicable you shall:• Ensure that your work is accurate, timely and in compliance withCentura policies, and federal and state laws and regulations.• Bill only for services actually rendered and adequately documentedin the medical record, using only billing codes that accuratelydescribe the services provided.• Immediately notify your supervisor and/or your Facility CorporateResponsibility Officer, the Centura Corporate ResponsibilityDepartment or Legal Department if inaccuracies are discovered so thatappropriate corrective action can be taken.• Ensure billing and medical record data is retained for periods prescribedby law and by Centura’s Record Retention Policy that mayrequire a longer period of retention.There is not always documentation for services we bill. Mymanager has told me to bill for the services even when I donot have documentation to support them. I know that it cantake a long time for all the documentation to come into the13