Below is a list of documentation that must be completed for the Medicare Ambulatory Surgery Center (ASC) Self Survey. Please mail completed documentation to AAAASF at P.O. BOX 9500, Gurnee, IL 60031 or fax to 847-775-1985. You may also scan and email to firstname.lastname@example.org.
- Facility Identification Form
- Staff Identification Form
- Facility Director Attestation Form
- Completed Standards Manual
Once received, please allow 10 business days for processing. If deficiencies are found, a report will be sent to the facility director allowing 10 calendar days for a Plan of Correction and 30 calendar days for proof of correction(s). Otherwise, once the documentation is processed, a new certificate will be mailed out to the facility at no cost.
AAAASF is required to conduct Validation Surveys on 5% of all Medicare Accredited Ambulatory Surgery Centers (ASCs) each year. As a Medicare provider, both the CMS State and AAAASF Central Office reserve the right to conduct an unannounced Validation Survey at any time during the certification process.
Please review the Standards and Checklist Manual carefully before submitting the completed documentation to AAAASF.