Medicare Certification vs. Accreditation: What's the Difference?

It's the baseline required to bill Medicare

Any ASC that wants to accept Medicare patients must be certified by CMS. Certification means the facility has been inspected by a state survey agency and found to meet the federal Conditions for Coverage — a set of minimum standards covering patient rights, environment of care, infection control, and clinical services.

It also applies to Medicaid and many private payers

Medicare certification is often used as the baseline by Medicaid programs and many private insurance companies. An ASC that accepts insurance is almost always Medicare-certified, even if the patient in question is not on Medicare.

Surveys happen every few years — and can be unannounced

State surveyors inspect certified ASCs on a roughly 6-year cycle (though the frequency varies by state and by complaint history). Facilities that receive complaints or have deficiencies may be resurveyed more frequently.

It's voluntary — and goes above Medicare's baseline

Accreditation by AAAHC, AAAASF, or The Joint Commission is a separate process from Medicare certification. An accrediting body applies its own standards — which are typically more detailed and more stringent — and conducts its own on-site surveys.

"Deemed status" means accreditation replaces the Medicare survey

Some accreditation bodies (including The Joint Commission and AAAHC) have CMS-recognized deemed status. This means that an accredited facility is accepted as meeting Medicare certification requirements without needing a separate state survey. The accreditor's inspection substitutes for the government one.

It's a higher bar — but it's voluntary

A facility can be excellent and not accredited. Accreditation requires time, cost, and organizational effort. Some smaller or newer facilities haven't pursued it yet. Some don't see value in it for their patient population. Its absence should prompt questions, not disqualification.

Medicare certification: required to bill Medicare

Every ASC that accepts Medicare patients must have it. It's a regulatory floor, not a mark of distinction. All 5,700+ facilities in this directory are Medicare-certified.

Accreditation: voluntary quality distinction

Roughly 60–70% of ASCs hold accreditation from one of the three major bodies. It signals that the facility has been reviewed against a higher standard and chose to undergo that scrutiny voluntarily.

Certification inspects minimum compliance; accreditation inspects quality systems

A Medicare survey primarily checks whether a facility meets minimum legal requirements. An accreditation survey digs deeper into quality improvement programs, staff competency, credentialing processes, and patient safety culture.

Both can be revoked for deficiencies

Medicare certification can be terminated for serious violations. Accreditation can be withdrawn or placed on probation if a facility fails to address findings. Both represent ongoing accountability, not a one-time approval.

Verify Medicare certification before any procedure

If you're on Medicare or Medicaid, confirm the facility is certified before scheduling. This is also a basic quality check for any patient — uncertified facilities are extremely rare but do exist (primarily in cash-pay cosmetic surgery).

Ask which accrediting body, if any

The answer tells you something about the facility's focus and how seriously it takes quality oversight. If a facility doesn't know or can't answer the question, that's worth noting.

Look up any inspection history

CMS publishes inspection results and deficiency reports for certified ASCs on the Care Compare website. A facility with a recent history of citations for infection control or patient safety should be evaluated carefully.