CMS proposes new ASC requirements

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The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule revising the requirements that ambulatory surgical centers (ASCs) must meet in order to bill Medicare for services furnished to beneficiaries. ASCs are typically free-standing facilities that perform outpatient surgery.

To participate in the Medicare program, an ASC must meet Medicare’s conditions for coverage. The proposed rule would update the existing ASC Conditions for Coverage to reflect contemporary standards of practice in the ASC community, as well as recommendations from the Health and Human Service Inspector General.

On July 16, 2007, CMS also issued a proposed rule setting payment rates, and adding procedures to the ASC-covered list, effective for ASC services performed on or after Jan. 1, 2008.

According to CMS, the proposed rule changes include:

  • A more comprehensive quality assessment and performance improvement condition (QAPI) that enables ASCs to take tailored proactive steps to ensure quality care;
  • Requiring the ASC’s governing body to be responsible for the oversight and accountability for the updated QAPI program;
  • Adding a new disaster preparedness plan standard to address emergency preparedness within the facility and interaction with local and state officials;
  • Adding requirements for radiologic services provided in an ASC to ensure they are parallel to the requirements for furnishing laboratory services;
  • Adding a new patient rights condition to address disclosure of physician financial interests in the ASC, advance directives, the grievance process and confidentiality of clinical records;
  • Expanding the infection control requirement to the condition level; and
  • Adding a comprehensive patient assessment requirement to ensure that accurate and thorough assessments are conducted to assure appropriate and safe surgery and that patients would be able to tolerate a scheduled surgical procedure.

Public comments on the proposed rule will be accepted until Oct. 30, 2007, and a final rule will be issued later this year, CMS said. The proposed rule is on display at the office of the Federal Register and is posted on the CMS web site at