Ambulatory Surgical Center Request For Certification In The Medicare Program {CMS-377}

CMS-377 - AMBULATORY SURGICAL CENTER REQUEST FOR INITIAL CERTIFICATION OR UPDATE OF CERTIFICATION INFORMATION IN THE MEDICARE PROGRAM. This form is used by Ambulatory Surgical Centers (ASCs) to request initial certification or update their certification information in the Medicare program. It collects details about the facility's identifying information, type of control, ancillary services, surgical specialties, and facility characteristics. The form ensures compliance with Medicare's Conditions for Coverage and facilitates certification or recertification through submission to the appropriate state survey agency. It includes an attestation of accuracy, instructions for completion, and a privacy disclosure in accordance with federal requirements. Submission of this form will initiate the process of obtaining a decision as to whether the Conditions for Coverage are met. www.FormsWorkflow.com