ASC Conditions for Coverage – Update

Date: May 30, 2009

Our website news section recently posted information regarding changes to the Conditions for Coverage for Ambulatory Surgery Centers effective May 18, 2009. Of particular interest to many of our ophthalmology clients is the need to provide patients with specific information prior to the date of surgery. The information must be provided verbally and in writing. The new guidelines state:

§416.50(a) Standard: Notice of rights
The ASC must also disclose, where applicable, physician financial interests or ownership in the ASC facility in accordance with the intent of Part 420 of this subchapter. Disclosure of information must be in writing and furnished to the patient in advance of the date of the procedure.

Prior to the May 18 effective date, CMS published an exception to the advance disclosure requirement. They state that an exception exists if the surgeon indicates, in writing, that it is medically necessary to perform the surgery on the same day and that the surgery is suitable for the ASC. This exception should be rare as most ophthalmic procedures performed in the ASC are not emergent.

§416.50(a)(2) Standard: Advance Directives
The ASC must comply with the following requirements:
(i) Provide the patient or, as appropriate, the patient’s representative in advance of the date of the procedure, with information concerning its policies on advance directives, including a description of applicable State health and safety laws and, if requested, official State advance directive forms.
(ii) Inform the patient or, as appropriate, the patient’s representative of the patient’s rights to make informed decisions regarding the patient’s care.
(iii) Document in a prominent part of the patient’s current medical record, whether or not the individual has executed an advance directive.

Some surgeons perform elective surgery (e.g., cataract surgery or YAG capsulotomy) on the same day as the patient’s initial evaluation. These surgeries would not meet the exception because they are not emergent. Advance notification will be required for these cases.

ASCs may provide the information verbally when the patient’s appointment is scheduled and subsequently send the patient written notifications using a variety of methods. Patients could receive them via the mail, fax or email. The method of delivery should ensure that the patient receives the information in advance of their scheduled appointment and anticipated surgery.

ASC surveyors will assess compliance with these and other conditions for coverage changes when conducting their surveys.

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