December 05, 2025

Episode 263 - Latest News, Delay in Pre-Auth Pilot, Anthem Policy, Final CMS ASC/HOPD 2026 Payment Rule - December 3, 2025

43 minutes

In this episode of the ASC Podcast with John Goehle we discuss the latest news, including the delay in the Pre-authorization pilot and Anthem’s new policy on out-of-network providers. In our focus segment we discuss the final 2026 CMS ASC/HOPD Payment Rule

This episode is sponsored by Surgical Information Systems, RFX Solutions, Medserve and Ambulatory Healthcare Strategies.

Notes and Resources from this Episode:

Final Rule:

https://public-inspection.federalregister.gov/2025-20907.pdf

Press Release about Final Rule:

https://www.cms.gov/newsroom/press-releases/cms-empowers-patients-boosts-transparency-modernizing-hospital-payments

Fact Sheet about Final Rule:

https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center

Downloads for the Final Rule:

https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1834-fc

ASC Quality Reporting web site:

https://www.qualityreportingcenter.com/en/ascqr-program/

ASC Association Web Site (Join to get more information):

http://ascassociation.org

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Important Resources for ASCs:

Conditions for Coverage:

https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=42:3.0.1.1.3&idno=42#se42.3.416_150

Infection Control Survey Tool (Used by Surveyors for Infection Control)

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107_exhibit_351.pdf

Updated Guidance for Ambulatory Surgical Centers - Appendix L of the State Operations Manual (SOM)

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_l_ambulatory.pdf

https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updated-guidance-ambulatory-surgical-centers-appendix-l-state-operations-manual-som

Policy & Memos to States and Regions

CMS Quality Safety & Oversight memoranda, guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices.

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions

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By John Goehle

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