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A Message from Stacy Mensah, Owner Welcome to the Q4 2025 edition of The Mensah Group Newsletter. This quarter marked significant regulatory activity. CMS finalized 2026 payment rules. AAAHC released updated survey standards. AHCA enforcement patterns shifted. Your compliance infrastructure requires attention before January 1. This newsletter covers what you need to know: and what you need to do: before the calendar turns. CMS 2026 Final Rules: Key Highlights OPPS Final Ru

ASCQR reporting errors cost ambulatory surgery centers real money. Miss a deadline or skip a measure, and CMS slashes your annual payment rate update by 2 percentage points. No exceptions. No grace periods. For ASC administrators juggling surveys, staffing, and daily operations, ASCQR compliance often slides down the priority list until it becomes urgent. This guide breaks down the most common reporting pitfalls and provides a practical roadmap to protect your facility's reim

First AHCA survey on the horizon. Nerves kicking in. Totally normal. The Agency for Health Care Administration doesn't announce visits. Surveyors appear when they appear: weekends, holidays, Tuesday afternoons. Preparation can't wait until the last minute. Good news: passing your first survey isn't about perfection. It's about systems, consistency, and knowing what surveyors actually look for. This guide breaks it down. The Year-Round Compliance Mindset Survey prep isn't a

Quality Assurance and Performance Improvement. QAPI. The program every healthcare facility needs: but few execute well enough to make surveyors nod approvingly. A QAPI program that impresses surveyors goes beyond checkbox compliance. It demonstrates a comprehensive, data-driven, and systematically documented approach to quality management. One that shows measurable improvement across all aspects of care delivery. Here's how to build one that actually works. Start with Leader

The Policy Question Every Practice Owner Faces Office-based practices operate under increasing regulatory scrutiny. Policies and procedures form the backbone of compliance, patient safety, and operational consistency. The question remains: generic templates or custom documentation? The answer requires examining what policies actually accomplish and where standard templates fall short. What Policies Do for Your Practice Policies serve multiple functions within healthcare se

Common misconception among ASC administrators: CMS and AAAHC represent competing accreditation paths. Reality differs significantly. CMS does not directly accredit ambulatory surgery centers. Instead, CMS approves specific organizations to accredit ASCs on its behalf. These approved accreditors grant what's known as "deemed status." AAAHC holds CMS approval. Earning AAAHC accreditation satisfies Medicare certification requirements automatically. The real question: Which CMS-a

Survey day at your Ambulatory Surgery Center. Surveyors walk through the door. Your team freezes. The next few hours determine whether you pass, receive citations, or face temporary closure. Most ASC administrators know this feeling. The stress. The uncertainty. The nagging thought that something got missed. Here's the thing: survey failures rarely happen because of one catastrophic mistake. They happen because of small, preventable oversights that compound over time. These a

State-level regulatory compliance. Often overlooked. Always critical. ASC administrators focus heavily on CMS requirements. Understandable. Federal surveys drive Medicare certification. But state regulations frequently differ from federal standards: and when they do, state rules take precedence. Lose state licensure. Lose Medicare certification. Simple equation. This guide covers the essentials: key regulatory areas, monitoring processes, responsibility assignments, and a pra

Short answer: yes. QAPI programs remain mandatory under CMS Conditions for Coverage. Surveyors actively review QAPI documentation. ASCs without functional programs face citations, plan of correction requirements, and potential jeopardy situations. The real question: Is your QAPI program working, or just existing on paper? What QAPI Actually Means for ASCs Quality Assurance and Performance Improvement. Two distinct functions combined into one program. Quality Assurance (QA):

The Regulatory Landscape in 2026 CMS 2026 final rule: significant expansion of the ASC Covered Procedures List (CPL). Between 289 and 302 new procedures added, including those previously on the Inpatient-Only (IPO) list. Five general exclusion criteria eliminated from CPL standards. Shifted to nonbinding physician considerations for patient safety. Greater clinician discretion. Greater ASC accountability. Bottom line: ASCs now have expanded opportunities: but must demonstrat

Survey day arrives. The surveyor walks through your doors: CMS, AHCA, or AAAHC. Your team scrambles. Binders get pulled. Staff freeze when asked basic compliance questions. Sound familiar? Most ASC citations stem from preventable gaps. Not negligence. Oversight. The difference between a clean survey and a corrective action plan often comes down to preparation that happens months before surveyors arrive. Here are seven mistakes ambulatory surgery centers make repeatedly: and e

The Centers for Medicare & Medicaid Services (CMS) finalized the 2026 Ambulatory Surgery Center (ASC) Payment System rule. Major changes ahead. ASC administrators and compliance leads: here's what to know. Disclaimer: This content is for informational purposes only. It does not constitute legal, financial, or regulatory advice. Consult qualified professionals for guidance specific to your facility. 1. Average 2.6% Payment Increase CMS approved an average effective payment u