Obtaining Medicare certification for an ASC involves the following four steps. It is a fairly involved process that should be started as soon as practical to assure that it is competed in a timely manner.
1. Obtaining a National Provider Identifier
The first step in Medicare certification is to obtain a National Provider Identifier (NPI) from the National Plan and Provider Enumeration System (NPPES
). The fastest way to receive a NPI is to apply via NPPES’s online system.
2. Enrolling in Medicare
The next step is enrolling in Medicare which can either be completed online via the Provider Enrollment, Chain and Ownership System (PECOS
) or by completing the paper 855b
form and mailing it to the Medicare Administrative Contractor (MAC) that serves your state
. CMS requires that ASCs revalidate their enrollment every five years. ASCs will be contacted by their states Medicare contractor and asked to revalidate. ASCs do not need to do anything until they are asked to revalidate.
3. Complying with Medicare’s Conditions for Coverage (CFCs)
CMS establishes requirements, called Conditions for Coverage that ASCs must meet in order to be certified. The requirements cover all aspects of an ASC from operational organization to facility design and patient care. It is important to note that the CFCs must be met for all patients and not just Medicare patients.
The CFCs are available here
beginning on page 212. Additionally, CMS produces “Interpretive Guidelines” for the CFCs. In addition to reiterating the text of the CFCs this document provides guidance on the meaning of the rules and further advice on how ASCs should comply. The “Interpretive Guidelines” are available here
4. Compliance Survey
CMS has granted four private organizations —the Accreditation Association for Ambulatory Health Care
(AAAHC), The Joint Commission, the American Association for Accreditation of Ambulatory Surgery Facilities, Inc.
(AAAASF) and the Health Care Facilities Accrediting Program
(HFAP) — the authority to determine whether or not ASCs are in compliance with Medicare’s CFCs. In addition each of these organizations provides accreditation for ASCs. While there is no federal requirement that an ASC be accredited some states and private payers require it. Contact these organizations here
Alternatively, ASCs can elect to be surveyed by their state’s Medicare agency
, though in practice this choice may not be viable due to limited state resources. It should be kept in mind that the state Medicare agency may survey an ASC after it is open.
Additional Medicare Compliance Resources
- Complying with the Life Safety Code--Medicare requires ASCs to comply with the 2000 edition of the Life Safety Code (LSC), updated and published by the National Fire Protection Association.