Define - ASC - What is ASC

DEFINITION OF AN ASC

An ASC for Medicare purposes is a distinct entity that operates exclusively for the purpose of
furnishing outpatient surgical services to patients. The ASC must enter into a participating
provider agreement with CMS. An ASC is either independent (i.e., not a part of a provider of
services or any other facility), or operated by a hospital (i.e., under the common ownership,
licensure or control of a hospital). If an ASC is the latter type, it has the option either of being
covered under Medicare as an ASC or continuing to be covered as a hospital-affiliated outpatient
surgery department. To be covered as an ASC operated by a hospital, a facility:

�� Elects to do so, and continues to be so covered unless CMS determines there is good cause to
do otherwise;

�� Is a separately identifiable entity, physically, administratively, and financially independent
and distinct from other operations of the hospital, with costs for the ASC treated as a nonreimbursable cost center on the hospital’s cost report;

�� Meets all the requirements with regard to health and safety, and agrees to the assignment,
coverage and payment rules applied to independent ASCs; and

�� Is surveyed and approved as complying with the conditions for coverage for ASCs.
If a facility meets the above requirements, it bills NHIC on Form CMS-1500 or the related
electronic equivalent and is paid the ASC payment amount.

If a hospital based facility decides not to become a certified ASC it bills the fiscal intermediary
(FI) on Form CMS-1450 or the related EDI equivalent and is subject to hospital outpatient billing
and payment rules. It is also subject to hospital outpatient certification and participation
requirements.