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

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 INFORMATION ABOUT THE ASC PODCAST WITH JOHN GOEHLE ASC Central, a sister site to http://ascpodcast.com provides a link to all of our bootcamps, educational programs and membership programs! https://conferences.asc-central.com/ Join one of our Membership Programs! Our Patron Program: Patron Members of the ASC Podcast with John Goehle have access to ASC Central - an exclusive membership website that provides a one-stop  ASC Regulatory and Accreditation Compliance, Operations and Financial Management resource for busy Administrators, nurse managers and business office managers.  More information and Become Member The ASC-Central Premium Access Program A Premium Resource for Ambulatory Surgery Centers including access to bootcamps, education programs and private sessions More Information and Become a Premium Access Program Members Today! 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 Other Resources from the ASC Podcast with John Goehle: Visit the ASC Podcast with John Goehle Website Books by John Goehle Get a copy of John’s most popular book - The Survey Guide - A Guide to the CMS Conditions for Coverage & Interpretive Guidelines for Ambulatory Surgery Centers