🎙️ Companion Episode Transcript: ASC Compliance Checklist for 2026
This is a transcript of our Podcast Episode, ASC Compliance Checklist for 2026.
You can access the Podcast Episode or read over the transcript for quick takeaways.
[Opening music fades in]
Host: Welcome back to our Ambulatory Surgery Center Compliance Series. I’m glad you’re here, because today we’re closing out the series with something incredibly practical — a clear, actionable ASC Compliance Checklist for 2026.
This episode is designed to be your quick‑reference guide. Whether you’re an administrator, a compliance officer, or a physician‑owner, this checklist will help you evaluate your ASC’s structure, operations, and financial relationships through the lens of what regulators are focusing on right now.
Let’s jump in.
Section 1: Ownership & Investment Structure
First, let’s talk about ownership — because this is where most ASC compliance issues begin.
Every year, you should confirm that each physician‑owner meets the one‑third tests that apply to your ASC type. That means they’re actually performing procedures at the ASC or in other ambulatory surgical settings, not just investing passively.
You also want to make sure every investor has real financial risk. That includes capital contributions, exposure to losses, and no preferential financing. If someone’s investment looks too easy, too protected, or too guaranteed, that’s a red flag.
And finally, distributions must never correlate with referral volume. If the numbers even appear to track referrals, regulators will take notice.
Section 2: Operational Participation
Next, let’s look at participation.
Every physician‑owner should be meaningfully engaged in performing procedures at the ASC. This isn’t just about meeting a threshold — it’s about demonstrating real involvement.
Track case volumes. Track income sources. And do it consistently. If someone is drifting toward the margins, address it early. Regulators care deeply about whether owners are actually using the facility.
Section 3: Referral Patterns & Financial Relationships
Now let’s talk referrals — because this is where enforcement has been heating up.
Review your referral data for outliers. Look for reciprocal referral patterns. Make sure no payments, bonuses, or distributions are tied to referrals, directly or indirectly.
If you have relationships with hospitals, management companies, or other entities, evaluate them carefully. Regulators are increasingly focused on whether these arrangements create remuneration risk.
Section 4: Anesthesia, Management, and Service Agreements
This is an area where ASCs often stumble.
Anesthesia arrangements must avoid anything that looks like “pay‑to‑play.” Management fees must reflect fair market value and cannot be tied to volume or value of referrals.
And if you have co‑management, consulting, or marketing agreements, review them with a critical eye. These are frequent sources of Anti‑Kickback Statute concerns.
Section 5: Safe Harbor Alignment
Even if your ASC doesn’t fit neatly into a safe harbor — and many don’t — you should still document how your structure aligns with safe harbor principles.
That includes:
- Bona fide investment risk
- Meaningful participation
- No referral‑based remuneration
- Commercially reasonable terms
Think of this as building a compliance narrative. If regulators ever ask, you want to be able to show your work.
Section 6: Billing, Coding & Documentation
Let’s shift to operations.
Conduct periodic audits of your billing and coding. Make sure documentation supports medical necessity and procedure selection. And confirm compliance with CMS Conditions for Coverage.
Billing issues may not be as flashy as ownership structures, but they’re just as important — and just as risky.
Section 7: Annual Compliance Review
Every ASC should conduct a structured annual review. That includes:
- Ownership structure
- Distributions
- Service agreements
- Referral analytics
- FMV assessments
This is your chance to catch issues before regulators do.
Section 8: When to Seek an Advisory Opinion
Finally, let’s talk about advisory opinions.
If your ASC structure is outside a safe harbor but still defensible, or if you have complex relationships with hospitals or management companies, an advisory opinion may be worth considering.
It’s not necessary for every ASC — but for borderline structures, it can provide clarity and protection.
Closing Thoughts
Host: And that’s your ASC Compliance Checklist for 2026.
This episode wraps up our ASC compliance series, but it also gives you a practical tool you can revisit throughout the year. Compliance isn’t a one‑time project — it’s an ongoing discipline. And with regulators sharpening their focus on ASCs, staying proactive is more important than ever.
[Closing music fades out]
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