Wednesday, June 10, 2020

About to enroll as a provider with CMS? Then read this...

Providers and suppliers can apply to enroll in the Medicare program using one of the following two methods:

  Internet-based Provider Enrollment, Chain and Ownership System (PECOS). Go to: 

 Paper application process: Download and complete the Medicare enrollment application(s) at 

DMEPOS suppliers should send the completed application to the National Supplier Clearinghouse (NSC). Any future application(s) can be mailed to the address below: 

USPS : FedEx/UPS: Provider Enrollment Noridian Healthcare Solutions 
PO Box 6775 Fargo, ND 58108-6775 

Provider Enrollment Noridian Healthcare Solutions 
900 42nd St S Fargo, ND 58103

If you have any questions, please contact our JE Office at 855-609-9960 between the hours of 8:00 a.m. and 4:00 p.m

Wednesday, January 8, 2020

CMS pays facility fees for surgery centers:

Medicare Payments: Facility Fee

Medicare pays for surgical procedures in an ASC unless the Centers for Medicare & Medicaid Services (CMS) determine that the procedures meet any of these criteria for exclusion.

The facility fee is designed to pay for the use of the ASC, including:
  • Nursing
  • Technician and related services
  • Diagnostic or therapeutic services or items directly related to the provision of a surgical procedure
  • Administrative, recordkeeping and housekeeping items and services
  • The operating surgeon’s supervision of the services  provided by an anesthetist
As a general rule, the facility fee also covers:
  • The drugs
  • Biological
  • Surgical dressings
  • Supplies
  • Splints
  • Casts
  • Appliances and equipment that are directly related to the provision of surgical procedures
  • Anesthesia materials and implants, including intraocular lenses (IOLs)
Medicare does, however, make a separate payment for certain drugs, including:
  • Some anesthetic agents
  • Biologics
  • Radiologic services
These separately payable items and services are considered ancillary services, and Medicare pays ASCs for them when they are provided in conjunction with a Medicare-covered procedure.

In addition, Medicare makes an additional payment for interocular lenses (IOLs) that have been designated as “New Technology” IOLs (NTIOLs). Currently, no IOLs are classified as NTIOLs. CMS, however, may designate certain IOLs as being NTIOLs in the future.

Tuesday, December 3, 2019


Medical gas systems are a standard feature of most healthcare facilities, and they require special monitoring and maintenance to ensure they are operating properly. Unlike other medical equipment and systems, their use of gas under pressure makes them vulnerable to a unique set of unexpected failures, which may not be readily apparent. This makes medical gas preventative maintenance critical to a problem-free working environment.

We understand you want your medical gas systems to be compliant and pass inspection, and most of all, increase safety for your patients. We understand it's crucial to keep your medical gas systems running smoothly so you have no unexpected failures, and you have the proper equipment to do your job competently and worry-free.

We are concentrated on making sure your hospital and your patients are getting all they need from your medical gas equipment.

According to NFPA code (5.1.15), all medical gas and vacuum systems need to have a routine maintenance program.

What does a routine maintenance program mean?
It means a program that puts patient safety first which is always a top priority. And helps healthcare facilities prepare for any survey process, on-going maintenance, and repairs that will mitigate failures.

Top Medical Gas System Maintenance Questions [We Can Help You Answer]

question and answers
Photo by Pixabay from Pexels

1. When was the last time your system was inspected?
Healthcare facilities need timely inspections on piping, outlets/inlets, valves, flex connections, alarms, and source equipment. A successful survey requires operational, maintenance, and repair information on hand.

2. Are you concerned that you are not receiving proper flow or pressure in your medical gas system?
National statistics show that the average minute spent in the operating room costs $72. Having improper suction in the operating room is a problem, both in terms of cost and safety because it means the removal of liquids, solids and waste gases may take longer than necessary.
This is due to the fact that an ideal flow rate may not be reached as a result of poor suction.

3. Are you concerned of a possible leak in your medical gas equipment?
Low suction or vacuum may indicate a leak in the system and may result in excess operational cost. Adequate vacuum at the wall in the operating room is needed to allow the physician to titrate the exact level needed for the task at hand.

A leak in a medical gas system in the ASC environment is a problem in terms of quality, cost due to material losses, and also one of safety. There can be an ongoing avoidable cost in terms of gas waste and overly frequent cylinder replacement, and more serious cost implications if a poorly functioning system leads to source equipment failure or longer procedure times.

The best approach, whether in a small clinic or a large MULTI-ASC, is to have a comprehensive medical gas preventative maintenance program in place to identify and avert these problems as soon as they arise.

4. Are you aware of the most current NFPA codes on required maintenance?
a. NFPA 99 2018,, states credentialing to the requirements of ASSE 6040 and ASSE 6030 are appropriate qualifications.
b. Code cites:  "Scheduled maintenance for equipment and procedures shall be established through the risk assessment of the facility and developed with consideration of the original equipment manufacturer recommendations and other recommendations as required by the authority having jurisdiction."
c. Nonstationary booms and articulating assemblies, other than head walls utilizing flexible connectors, shall be tested for leaks, per manufacturer's recommendations, every 18 months or at a duration as determined by a risk assessment.

5. Do you know the original equipment manufacturer recommendations for each component in the medical gas system?
Within code an ASC should reference what the equipment manufacturer recommends.
Different items need to be checked daily, weekly, monthly, and annually based on the equipment and sub equipment. The main point is maintenance on medical gas equipment cannot be overlooked or ignored, despite the technologies employed or the frequency of use. Equipment is directly connected to patient care, patient and employee safety.

6. Was your system inspected & tested by a qualified individual?
Compliance requires that all inspections, testing, and maintenance are conducted by qualified personnel. For any new installations, additions, or renovations, a verification is required. To become an ASSE 6030 Verifier, an individual must have at least two years of documented practical experience in the verification of medical gas systems, as well as completion of a minimum 32-hour training course instructed by an ASSE 6050 instructor.
Persons maintaining systems shall demonstrate appropriate qualifications by attaining their ASSE 6040 Maintenance Personnel qualification, 6030 qualification, or complete a documented training program acceptable to the facility.

7. Do you manage medical gas repairs and maintenance with a computerized monitoring solution?
The best approach is to have a computerized monitoring solution in place that monitors the whole system, from the source of the gas, through the piping and finally to the patient. A fully-featured software program provides to ability to map out the entirety of your piped gas system, with individual components barcoded for easy identification and replacement if necessary.
You ideally want a software solution that allows you to access information on required medical gas preventative maintenance from multiple computer stations.

8. Are you aware of all your medical gas equipment that does not use "oil"?
Equipment that does not use oil often may also have no maintenance plan at all because the ASC believes there is nothing else needed to do, but all life safety equipment has to be cycled regularly to assure it will work on demand.
Also, equipment that uses no oil still requires an in-depth maintenance program and when overlooked/ignored the equipment will wear down and fail to operate. This is not only equipment that isn’t used often, but equipment that can be used every day, every hour.

9. Do you properly monitor your central supply systems?
The medical gas source equipment used will vary, depending on the type of gas and the size of the institution. For smaller needs, cylinder-only solutions are often adequate.
For large hospitals with substantial requirements, cyrogenic liquid systems may be utilized to provide piped gas. Compressors are also used to provide medical air, and vacuum pumps are needed for suction. Failing to properly monitor these complex pressurized systems can be costly, both in terms of increased use of consumables and damage to permanent equipment.

Guidelines written in search bar on virtual screen
Preventative Maintenance means inspecting, testing and updating source equipment that supply the array of gases used in the ASC: Medical air, Nitrous Oxide, Carbon Dioxide, Medical-Surgical Vacuum and Waste Anesthesia Gas Disposal (WAGD). 

PM means checking the components of each supply system to verify their proper operation and inspection of the machines' parts for wear or obstruction.
  • Each pump or compressor has an hour meter that shows how much it has been used. All medical gas source equipment shall be redundant: that is, the  primary supply that has a companion, perhaps duplexed or multiplexed, that are always on standby in the event the primary pump fails or is unable to keep up with demand. Regular alteration of components is key. The length of run time prescribes oil changes and other checks of critical components.
  • Filters are checked and often replaced to make sure the output meets applicable standards.
  • Belts and mechanical connections between the drive system and the pump or compressor are checked to verify they are working well, and to detect labored operation of the pump.
  • If oil is used it is checked for condition and level. Oil use indicates worn parts inside the pump.
  • The drains are checked to verify free flow and proper operation. As air is compressed it “wrings” the humidity out of the air and this water must have a clear path to the drain or it can back up into the compressor itself.
  • The voltage and amperage of the running pump are checked to verify it is operating to the manufacturer’s specifications. An electrical motor pulling more than the specified electricity signals worn internal components and labored operation.
  • The audible and visual indicators are checked to verify they are lit when they should be and they will light up when a default condition exists. Likewise, all the various alarms are tested to ensure proper set points.
  • The operating temperature of the unit is monitored and the high temperature shut off is activated to avoid burning out a pump or compressor.
  • The valves and rings are checked in reciprocating compressors.
  • The actual dew point (or the amount of water in the output) is measured and compared to the set values of the dew point alarm. Some water in the air makes breathing easier for patients, but too much can clog lines, equipment and actually labor breathing.
  • The room condition is noted as well. There should be regular airflow to the external ventilation to prevent overheating.


Surgery Centers today need ways to confirm that all the equipment and devices that affect life safety are working to spec and are reliable.

Friday, November 1, 2019

Benchmarking Studies by a collective group of surgery centers across the USA.

These are the studies to rank how well your facility is doing by this national benchmarked areas within your ASC.  They are:

Operational benchmarks

1. Administrator salary is $109,184. 1

2. Administrators in the west receive the highest salary, at $114,109 while administrators in the Midwest receive the lowest salary at $104,317.

3. Staff hours per case at ASCs is 12.8 hours.

4. Administrative hours per case is four hours.

5. Nurse hours per case in one- to two-OR centers is 5.2 hours.

6. Administrative hours at one- to two-OR centers is 3.8 hours.

7. Nurse hours at ASCs with three- to four-ORs is 6.3 hours.

8. Administrative hours at ASCs with three- to four-ORs is 4.1 hours.

9. ASCOA surgery centers have a per room goal of 10 cases per day to encourage compressed schedules. 2

10. GI and pain-driven centers with less than five clinical hours would have a total of around eight staff hours per case.

11. Centers with more complicated cases such as orthopedics and spine would have clinical hours around seven to eight hours per case and total staff hours around 10 to 12 hours per case.

12. Average room turnover time goal is seven to 10 minutes at ASCOA surgery centers, depending on the case mix.

13. 53 percent of ambulatory surgery centers maintain paper records and 23 percent track their supply chain on spreadsheets. 3

14. Typical surgery centers have 19 cases per day. 4

15. 74 percent of the cases are performed by the top five physicians at the ASC.

16. ASCs have of three surgical cases per operating room per day.

17. Total operating expenses per OR is $1.2 million.

18. Employee salary and wages per operating room is $421,820.

19. Medical and surgical expenses per OR are $375.37.

20. General and administrative expenses per OR are $259.38.

21. Total cases per center is 4,714 per year.

22. Average number of non-surgical cases per year is 1,146.

23. 765 cases are performed per operating room annually, with 4.6 cases per day.

24. ASC procedure rooms see around 1,144 non-surgical cases per room annually, with 4.6 procedures per day.

25. The top five physicians performed 54 percent of the ASC's case volume.

26. Surgery centers with more than four operating rooms performed 24 cases per day, while those with one to two operating rooms performed 12 cases per day.

27. Surgery centers with one to two operating rooms had the highest annual surgical case rate per operating room, at 782, while those with more than four operating rooms hosted 744 cases annually per operating room.

28. Non-surgical case volume per year at facilities with one to two operating rooms is 1,017 cases per procedure room.

29. Surgery centers with three to four ORs reported 769 non-surgical cases per procedure room annually, which dropped to 705 cases in centers with more than four ORs.

30. In surgery centers with more than four ORs, only 22 percent of the cases were performed by the top two physicians, while 62 percent were performed by the top 10 physicians.

31. Median operating room time per patient encounter: 50.2 minutes. 5

32. Procedure room time per patient encounter: 34.2 minutes.

33. Median rate of unscheduled direct transfers: .6 transfers per 1,000 patient encounters.

34. 34 percent of ASC leaders plan to standardize products used in their center. 6

35. 24 percent plan to evaluate their GPO.

36. 19 percent plan to implement an order management system.

37. 6 percent plan to change or join a GPO.

38. 6 percent plan to change distributors.

Revenue cycle benchmarks

39. 79.9 percent of ASCs collect between 0 to 30 days from the date of service to the check date. 7

40. 13.3 percent of ASCs receive cash collection between 31 and 60 days from the service date to the check date.

41. 20 percent of ASC claims are not collected for more than 30 days. 8

42. The top reason for ASC procedures to receive an unexpected denial is "claims or service lacks information which is needed for adjudication." The second most common reason is "duplicate claim or service" followed by "procedure or treatment is deemed experimental or investigational by the payer."

43. Commercial insurance companies have a 12 percent unexpected denial rate for the top 10 CPT codes that have unexpected denials at ASCs.

44. Medicare's unexpected denial rate is 6 percent for the top 10 CPT codes that have unexpected denials at ASCs.

45. Medicaid has a 26 percent denial rate for the top 10 CPT codes that have unexpected denials at ASCs.

46. Around 47 percent of ASCs with fewer than 3,000 cases have 0 to 30 A/R days, while 18.7 percent have 31 to 60 A/R days. 9

47. Most ASCs with at least 6,000 cases annually have 0 to 30 A/R days.

48. Of all ASCs, about 15.9 percent have more than 120 A/R days.

49. For ASCs with three to four ORs, average ENT revenue is $1,734 per case.

50. Average GI/endoscopy revenue per case for medium-sized ASCs is $776.

51. Orthopedics revenue per case for three- to four-OR ASCs is $2,617.

52. Average general surgery revenue per case for medium sized ASCs is $1,721.

53. For ASCs with three to four ORs, average ophthalmology revenue is $1,249 per case.

54. Average plastic surgery revenue per case for medium-sized ASCs is $1,516.

55. Podiatry revenue per case for three- to four-OR ASCs is $2,021.

56. For medium sized ASCs, average OB/GYN revenue per case is $1,958.

57. Average pain management revenue per case for three- to four-OR ASCs is $890.

58. Revenue per case for urology procedures in medium-sized ASCs is $1,476.

59. ASCOA centers have a goal of low-to-mid 30s for A/R days out. 10

Clinical benchmarks

60. 89 percent of patients wait at least a month after scheduling cataract surgery before undergoing the procedure.11

61. 96 percent of patients are able to schedule their cataract surgery at their desired time in the ASC.

62. 94 percent of patients resume daily living within a week of undergoing cataract surgery.

63. 94 percent of patients reported improved vision after cataract surgery in an ASC.

64. 98 percent of patients say they're comfortable while undergoing cataract surgery in the ASC and 99 percent are comfortable after discharge.

65. 99 percent of patients report they would recommend cataract surgery after undergoing the procedure in an ASC.

66. Pre-procedure time is 81 minutes for cataract surgeries.

67. Procedure time for cataract surgeries in ASCs is 14 minutes.

68. Discharge time for cataract surgeries is 21 minutes.

69. 77 percent of colonoscopy patients report little or no discomfort during bowel preparation. 12

70. 81 percent of colonoscopy patients wait less than a month between scheduling their colonoscopy and having the procedure.

71. 98 percent of colonoscopy patients report being comfortable after discharge.

72. 99 percent of colonoscopy patients report little or no discomfort during the procedure and would recommend it to others.

73. 100 percent of colonoscopy patients report understanding the procedure.

74. Colonoscopy procedure time is nine to 29 minutes.

75. Pre-procedure time for colonoscopy is 17 to 129 minutes, covering patient check-in to scope insertion.

76. Colonoscopy discharge time is 15 to 75 minutes for ASCs.

77. Pre-procedure time for knee arthroscopy is 88 minutes, and organizations with shortest times attribute results to calling patients the day before to remind them of the appointment and pre-procedure requirements.13

78. Knee arthroscopy procedure time is 28 minutes in the ASC.

79. Discharge time for knee arthroscopy is 75 minutes in the ASC, and organizations with short discharge times attribute results to having patients leave the operating room as they are waking up to assess their comfort level as soon as possible.

80. 75 percent of knee arthroscopy patients wait less than a month for their procedure after scheduling.

81. 89 percent of knee arthroscopy patients are able to schedule the procedure as soon as they wanted in the ASC.

82. 99 percent of knee arthroscopy patients say they are comfortable post-discharge in the ASC.

83. Pre-procedure time for low back injections is 43 minutes, and organizations with the shortest discharge times attribute results to not using or using low levels of sedation or controlling the type and amount of medication administered. 83

84. Procedure time is seven minutes for low back injections in the surgery center.

85. Discharge time after low back injections in the ASC is 22 minutes, with a range of one to 42 minutes.

86. 90 percent of patients wait less than a month from scheduling their low back injection to undergoing the procedure in the ASC.

87. 93 percent of patients say they are able to schedule their low back injections in an ASC within a "reasonable" period to time.

88. 85 percent of patients report returning to daily activities after undergoing low back injections in ASCs.

89. 80 percent of patients say they experienced less pain after the low back injections, and 50 percent reduced pain medications after the procedure.

Growth benchmarks

90. 100 percent of surgery center management companies in the HealthCare Appraisers 2013 ASC Valuation Survey found orthopedics/sports medicine a desirable specialty. 15

91. 94 percent of ASC management companies find orthopedic spine a desirable specialty in 2013.

92. 94 percent of ASC management companies find ENT desirable in 2013.

93. 88 percent of ASC management companies find general surgery desirable in 2013

94. 88 percent of ASC management companies find pain management desirable in 2013.

95. 82 percent of ASC management companies find gastroenterology a desirable specialty in 2013.16

96. There were 113 new Medicare-certified ambulatory surgery centers in 2012.

97. Medicare made $3.5 billion in payments to ambulatory surgery centers in 2011.

98. There were 5,344 Medciare-certified ambulatory surgery centers in 2011, up 1.8 percent over the previous year.17

99. Between 2001 and 2011, the number of ambulatory surgery center operating rooms doubled in the United States and in 2011, 60 percent of hospitals had an ASC within five minutes of their facility. 18

100. Objective Health predicts that procedure volumes for cases such as shoulder arthroscopy, which Medicare paid ASCs 42 percent lower than hospital outpatient departments in 2012, will continue to increase in ASCs.


1. VMG Multispecialty ASC Intellimarker 2011.
2. Based on benchmarks provided by ASCOA
3. 2011 supply chain survey from Provista.
4. 10 Statistics on Surgery Center Case Volume based on VMG Multispecialty ASC Intellimarker 2011.
5. ASC Association's Outcomes Monitoring Project 2nd Quarter 2010 Report
6. 2011 supply chain survey from Provista.
7. RemitData, based on 25 percent of all national outpatient remittances from September 2012.
8. RemitData, based on data collected between Nov. 5, 2012 to Feb. 11, 2013.
9. VMG Multi-Specialty ASC Study 2011 Intellimarker
10. Benchmarks provided by ASCOA
11. Benchmarking study from AAAHC based on clinical studies of cataract extraction surgeries with lens insertions. The study includes 92 organizations with a combined 170,000 cataract surgeries per year.
12. Benchmarking study from AAAHC on clinical findings for colonoscopy from 100 organizations performing 353,300 colonoscopies between July and December 2012.
13. Benchmarking study from AAAHC on clinical findings for knee arthroscopy in the ASC based on data from 41 organizations that perform a combined total of 9,190 knee arthroscopies annually. The study was conducted between July and December 2012.
14. Benchmarking study from AAAHC on clinical findings for low back pain in ambulatory care settings based on data from 31 organizations that perform a combined total of more than 64,890 low back injections annually. The data was collected between July and December of 2012.
15.  HealthCare Appraisers 2010 ASC Valuation Survey and 2013 ASC Valuation Survey.
16. MedPAC Health Care Spending and the Medicare Program June 2013 Report.
17. March 2013 Report to the Congress: Medicare Payment Policy.
18. Objective Health Infographic: The Increased Competition of Ambulatory Surgery Centers (ASCs) to US Hospitals.


Monday, September 9, 2019

Most common deficiencies for AAAHC-ASC

Most common deficiencies for AAAHC Chapter 2 “Governance”, Subchapter I “General Requirements” In order to avoid deficiencies for Governance I, the governing body must meet a minimum of once a year and keep documented minutes. Most centers have a board that meets and keeps minutes; however, the minutes must include an annual review of the items below. Minutes lacking this approved list is the most common deficiency surveyors see for Subchapter 2.I: 1. Rights of Patients 2. QI Management & Improvement Program 3. Infection Prevention and Control Program 4. Annual Safety Program 5. Policies and Procedures 6. Scope of Care 7. Job descriptions for officers such as Director, Administrator, and Medical Director These items are simple to add to the annual board minutes and also meet Standard G: Annual Review of AAAHC accreditation requirements. Another often deficient Standard is D that requires: “Within 15 Calendar days of significant organization ownership, operational, or quality of care events, the organization notifies AAAHC of the event in writing.” Some organizations fail to let AAAHC know when: 1. The name of the organization changes 2. Majority ownership changes 3. Re-location of the center or an addition in number of ORs 4. Anesthesia level change from MAC to General 5. Change from single specialty to multi-specialty 6. Change in management company or administrator Kristine Mighion

About to enroll as a provider with CMS? Then read this...

Providers and suppliers can apply to enroll in the Medicare program using one of the following two methods:   Internet-based Provider Enrol...

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