ASC Enrollment

To provide services in an Ambulatory Surgery Center (ASC) and bill for those services, a facility must be certified as meeting the requirements for an ASC. Part of the ASC enrollment process requires certification achieved by a survey being conducted. This shows compliance with the conditions for coverage by state regulation.

View ASC enrollment details on this page.

Overview

  • An ASC is a facility that provides outpatient surgical and diagnostic services for providers
    • The expectation is that the surgery is not too risky for patient to receive and that a patient does not need an overnight stay to recover
  • Regulated by state and federal government
  • ASCs can be at a fixed location or mobile unit
  • It is not permittable for an ASC and another entity, such as an adjacent physician's office, to mix functions and operations in a common space during concurrent or overlapping hours of operations
  • ASCs are not permitted to share space, even when temporally separated, with a hospital or Critical Access Hospital outpatient surgery department, or with a Medicare-participating Independent Diagnostic Testing Facility (IDTF)
  • CMS does permit two different Medicare-participating ASCs to use same physical space, so long as they are temporally separated. That is, the two facilities must have entirely separate operations, records, etc., and may not be open at the same time
  • ASC may be either hospital-operated or independent
  • If a hospital-based surgery center is not certified as an ASC, it continues under the program as part of a hospital. In that case, the applicable hospital outpatient payment rules apply. This is the outpatient prospective payment system (OPPS), for most hospitals, or may be provisions for hospitals excluded from OPPS.

Effective Dates

  • Effective dates for ASCs are determined by the CMS Regional Office
    • This can take 6 months or longer for regional office to make their decision
  • Contact will receive a Recommendation for Approval letter
    • This does not mean application is completed. Noridian will send this request to CMS to review and approve enrollment
  • Tie-in letter will be sent to contact on application along with Noridian
    • ASC applications that require an additional site visit will have 45 days to complete application once Noridian receives Tie-in letter
    • ASC applications that do not require a site visit will be completed within 21 days once Noridian receives Tie-in letter

Enrollment Options

Option A

 

  • ASC only billing facility charge
    • Provider Enrollment, Chain and Ownership System (PECOS) application or CMS 855B with Provider Type of ASC selected
    • No reassignments for this type of enrollment
  • Clinic/group billing for professional services at ASC
    • PECOS application or CMS 855B paper with Provider Type of Clinic/Group Selected
    • PECOS application or CMS 855I/R paper for rendering providers
      • Submit a PECOS application or CMS 855I/R paper with PECOS application or CMS 855B paper application. This will allow provider to have a similar effective date as clinic/group enrollment
  • If ASC is billing ASC charge separately from Professional Services, we suggest a separate National Provider Identifier (NPI) for ASC. This is not a requirement

Option B

 

  • ASC billing for facility and professional services
    • PECOS application or CMS 855B paper with Provider Type of ASC selected
    • PECOS application or CMS 855I/R paper for rendering providers
      • Submit PECOS application or CMS 855I/R paper with a PECOS application or CMS 855B paper application. This will allow provider to have a similar effective date as ASC enrollment

 

Application Process

  • If completing application via PECOS, ensure application questionnaire is answered correctly. CMS 855B, CMS 588 (Electronic Funds Transfer (EFT)) application will populate
  • CMS 855R will also populate if applicable. (See Enrollment Options above)
  • If completing the application via paper, the following will be submitted:
  • CMS 855B application
  • CMS 588 (EFT)
  • CMS 460 (Participation agreement)
  • To participate in Medicare program means that provider/organization agrees to accept assignment for all services furnished to Medicare beneficiaries. Becoming a Participant means you agree to accept amount approved by Medicare as total payment for covered services
  • CMS 855I and CMS 855R (Optional/See Enrollment Options above)
  • Applications cannot be sent in more than 180 days prior to effective date listed on application
  • Accreditation must be submitted with application. On application include name of accrediting body along with effective date and expiration date
  • If application for accreditation is not complete/pending, only name of accrediting body must be completed
  • A copy of accreditation must be sent in with application
  • Fee is required for application. This can be paid on the PECOS website
  • Select pay application fee on right-hand side under Helpful Links
  • A voided check or signed bank letter is needed documentation for EFT portion of application
  • This must include legal business name (LBN) of ASC, routing and account number and practice address
  • If ASC has a doing business name (DBA) for a fictitious name, this can be on check but must be placed below LBN
  • IRS document showing tax identification number for ASC
  • A copy of CP-575 or 147C is required

Application Completion

For submitted application to process with minimal errors, consider information below

  • Physical location and Special Payments address
    • When completing this section via PECOS, there is a possibility of an USPS error. This is a common error during application process. Select USPS verified address
    • Complete special payments address. There can only be one special payments address per Provider Transaction Access Number (PTAN)
    • Special payment address is required to be one of below choices
      • One of practice locations listed in application
      • PO Box
      • Address of billing agency listed in application
      • Correspondence address listed in application
  • Geographical Location and Base of Operations
    • If ASC is mobile, a base of operations must be completed in application
      • Base of operations is the location from where personnel are dispatched, where mobile/portable equipment is stored, and when applicable, where vehicles are parked when not in use
      • There can only be one base of operations per enrollment
    • When filling out the base of operations, the geographical location must be completed on the application.
      • Either entire state or certain cities can be entered into this section/topic
      • If entire state of California is entered, enrollment will receive three PTANs. See explanation.
      • If certain cities are entered, enrollment will receive a PTAN per pay locality. See explanation.
  • Vehicle information is required if enrollment is a mobile unit
    • Every vehicle enrollment will operate must be on application
    • For each vehicle, a copy of all health care related permits, licenses or registrations must be submitted
  • Organization with ownership interest and/or managing control
    • Any organization that exercises operational or managerial control over supplier, or conducts day-to-day operations of supplier, is a managing organization and must be reported
    • ALL organizations that have any of the below must be listed organization with ownership interest and/or managing control section/topic:
      • Five percent (5%) or greater direct or indirect ownership interest in the supplier    
      • Interest must be equal to or more than 5% of property and assets
      • A partnership interest regardless of percentage of ownership, or whether partner is a general partner or limited partner
      • Managing control of supplier. Any organization that exercises operational or managerial control over supplier, or conducts day-to-day operations of supplier, is a managing organization and must be reported. Organization need not have an ownership interest in supplier to qualify as a managing organization. For instance, it could be a management services organization under contract with supplier to furnish management services for the business
      • Owning and managing organizations generally fall into one of these categories: corporations (including non-profit), partnerships and limited partnerships, limited liability companies, charitable and religious organizations, governmental/tribal organizations
  • Supply any Final Adverse Legal Actions sustained by the Organization with ownership interest and/or managing control
    • If completing via PECOS, select yes or no to final adverse legal action topic
    • If completing via paper, ensure section 5B is completed for each organization added in this section
    • Submit final outcome documents or current status of final adverse legal action
  • Attach an organizational flowchart identifying all organizations in this section/topic
  • Example of flow:
    • ASC Organization LBN > Name of Organization with Ownership > Owners within Organization with Ownership
  • Individuals with ownership interest and/or managing control
    • All individuals with ownership or managing control in enrolling organization must be listed in this section/topic
    • Individuals must be listed in this section/topic if they are one of the below
      • A 5% or greater ownership in supplier
      • Authorized Official (AO)
        • Authorized Officials must be:
          • 5% direct owner of provider or supplier
          • Have ownership interest or control of provider or supplier as:
            • President
            • General partner
            • Chairman of the board
            • Chief financial officer
            • Chief executive officer
    • Delegated Official (DO)
      • Delegated Officials must be:
        • Having ownership of control interest
        • W-2 managing employee. He/she can be the following:
          • General Manager
          • Business Manager
          • Administrator
          • Operational or Managerial control over operations
      • Managing Employee
      • Director
      • CEO/CFO
      • Sole Owner
    • Interest must be equal to or more than 5% of property and assets
    • Directors/Officers (Members of the Board)
    • A partnership interest regardless of percentage of ownership, or whether partner is a general partner or limited partner
    • Managing control of supplier
    • At least one managing employee must be indicated on application. Managing employee can be a W2 or Contracted Managing Employee
    • Supply any Final Adverse Legal Actions sustained by individual with ownership interest and/or managing control
      • If completing via PECOS, select yes or no to final adverse legal action topic
      • If completing via paper, ensure section 6B is completed for each person added in this section
      • Submit final outcome documents or current status of final adverse legal action
    • Contact Person
      • It is vitally important that the person in contact section will be with company for many years
      • This person will receive correspondence from Noridian and CMS Regional Office regarding application
      • If additional information is needed for application to continue processing, a development request will be sent to the contact. Contact person will have 30 days to complete information requested
      • If it is not supplied within 30 days, application will be rejected
      • If this section is not completed, development request along with all correspondence will be sent to AO/DO listed in application
    • Signatures
      • When signing application, AO must sign for CMS 855B, CMS 588 and CMS 460 (If enrollment wishes to be paid at PAR rate). No one else may sign initial enrollment application
      • These cannot be a stamp or a photo copy

Resources

Last Updated Fri, 14 Feb 2020 15:27:22 +0000