105. Mass. Code Regs. 140.308. - Ambulatory Surgery Center Reporting and Reimbursement for Serious Reportable Events

“Ambulatory Surgery Center Reporting and Reimbursement for Serious Reportable Events”
 
“Serious Reportable Event” (SRE) means an event that occurs on premises covered by an Ambulatory Surgery Center's (ASC) license that results in an adverse patient outcome, is clearly identifiable and measurable, has been identified to be in a class of events that are usually or reasonably preventable, and of a nature such that the risk of occurrence is significantly influenced by the policies and procedures of the ASC. 
An SRE must be reported within seven days of the date of discovery by filing a “SRE report” to the Department and providing a copy to any responsible third-party payer.  The ASC must inform the patient of the occurrence of the SRE, of its policies regarding the review process and the option to receive a copy of the SRE report filed with the Department. An ASC may not charge or seek reimbursement from a patient or responsible third-party payer for services provided as a result of an SRE occurring on premises covered by the ASC's license if the ASC determines that the SRE was preventable, within the ASC's control andunambiguously the result of a system failure.Any dispute(s) arising between the ASC and any responsible third-party payer resulting from a charge or claim for reimbursement for services provided by the ASC as a result of an SRE shall be addressed through the third-party payer's provider claims appeals process. This provisionmust not be construed to prohibit a Medicare provider from submitting a claim for reimbursement to the Medicare program.