Tuesday, November 17, 2009

Medical Screening Exams

At our facility, the RN's perform the Medical Screening Exam (MSE for short).  An MSE is the initial exam you receive in the ER to determine if your need is emergent or non emergent.  This must be done before any financial information is requested from the patient (such as insurance info).  Basically, it's a quick assessment and any testing that may be needed (such as a quick lab draw or xray) to determine if you truly need to be seen and use up ER resources.  An MSE is required by our government so that we don't dump you on some other hospital or refuse to treat your emergency if you don't have insurance.

Let us discuss......


Because some things drive me to drink and this is one of them.  

#1 - This does not, I repeat, NOT mean that you are entitled to a free ER visit.  We DO get to charge you.  We just cannot ask for financial info until after the MSE.  Some hospitals happen to not charge for MSE's that are not seen by a physician, but every facility is different and can choose what they charge for.

#2 - An MSE is NOT an ER visit.  It is a screening to determine if your situation is emergent or not.  Emergent means life or limb threatening, or acute pain.  Example:  A stroke is emergent.  A sprained ankle is not.

#3 - If we deem your visit as non emergent, we do have the right to tell you so.  We also may tell you (but not always) that there is NO need for you to be seen in the ER and that you should follow up with your primary provider.  Follow ups can even wait until Monday.  Yes - they can.  If you are seen in the ER anyway (either because you insist on it or because the facility allows it), you will probably have a tremendously long wait (think 6-8 hrs) because the emergent patients come first.  You come last.  Sorry, that's just the way it is. 

#4 - If you do not have a primary provider - get one.  If you do not have insurance to see a primary provider, what makes you think that going to an ER will be any cheaper?  We are usually 4 or 5 times the cost of going to a doctor's office.  Example:  office visit for sprained ankle approx $100.  ER visit for sprained ankle approx $600.  Most physician's offices will work with you to arrange payment options.  Yes, even those that ask for money up front.

Side vent - for those who say they cannot get in to see a physician because they have not established previously with the practice, take the time to do so on a day you have some free time.  That makes it so much easier for you to get that appointment for a sore throat when you call the doctor's office.  If they already have seen you and you've established care, they can put you into the open slots they save for daily immediate care cases.   

#5 - We'll ask for money too.  We just won't ask until the MSE is complete.  That means we may tell you that you need to pay your $100 copay (average ER copay) up front before being seen any further.  Yes, we are an ER but we are also a business.  

#6 - If your visit is deemed Emergent, then you will be seen regardless of insurance, ability to pay, or any other defined item.  You will be taken care of.  Period.  But...... it is our decision to make.  Not yours.  

#7 - Even if a physician performs your MSE, these same rules apply.

Now let's move on to the nurses, because we have some stuff to learn too.

SHHH - don't tell anyone I said that out loud.

#1 - Not every person needs to be seen in the ER.  It is OKAY to MSE them and discharge them out of the ER for follow up with their primary provider.  
#2 - YES - even if they have no insurance to be seen at a clinic.  Do you think that means we'll ever get paid?  We do not (yet) get government reimbursement for non emergent visits. 

#3 - Standing Orders may be used for MSE's.  As long as your policy says so, then do so.  Think of it this way - if you have a Chest Pain come in, do you wait for the MD to come up from the cafeteria and give you an order for an EKG before you do one?  Didn't think so.  I bet you use your cardiac standing order sets (or some such name). 

#4 - And for you overachievers out there....... when in doubt, have them seen by the ER doc.  We are not allowed to diagnose a patient.  Remember your scope of practice.  

#5 - Last but not least, an MSE is a whole different monster than Triage.  Triage determines who should be seen in what order.  An MSE determines if they should be seen at all.  

Of note for all you medical peeps out there:  Our state has determined that it is within the Scope of Practice for an RN to perform Medical Screening Exams as long as a proper orientation and monitoring program is set up and followed.  

And apparently I am supposed to remind you that this is my OPINION and not a teaching tool for MSE's.  If you'd like a teaching tool, you may contact me via email and I will share our MSE orientation packet and monitoring program.  It's not big, nor is it impressive.  Just warning you now. 

Alrighty then, I am off to pour a glass of vino because just typing this out made my head hurt.


Anonymous said...

Hate your job, your co-workers and your pts much?

Linn said...

If you come to the ER in Norway with a sprained ankle it will cost you 85 USD including X-ray.

satish said...

well,You are right in every aspect. Liked your post

Julie said...

Oh Anonymous, Anonymous. How misunderstood art thou? Alas, I do not hate my job, my coworkers, nor my patients much. They provide endless hours of blog fodder and entertainment. Much like you! Thanks so much!

Julie said...

Thanks Satish.

Linn - so much cheaper than here!

Anonymous said...

Hi Julie,
Loved your post--
I have a couple of questions, I work for a TPA and cannot find the correct coding quidelines for the MSE--can you please help---
Also, I have been trying to find a standard list of "True" Emergent ICD-9 codes, but alas have had no luck--would you be able to point me in the right direction for this?
Thanks for your time---

Mary said...

I would love to see your hospital protocol for nurse MSE as well as nurse orientation. How do I e-mail you?

Julie said...

@Mary - if you'd like to contact me, then you must post your email addy. I don't give mine out unless you are a proven non spammer.

I can send both of you the information you need.

Anonymous said...

Amen!! Love it...We just started this a few months ago but the providers do the screening...well a few of them. There are
many that will never screen anyone out!! Anyway, I wish our nurses could do it :)