Eligible applicants can access the application through the Facility Portal.

• Create a user registration within MedConcert and begin the APEx application.
• The ROP submits information about facilities including, annual number of new patients treated, treatments offered, equipment and physician names. 
• Information on all currently commissioned radiation therapy equipment. 
• A signed facility agreement and HIPAA business associate agreement. 
• Nonrefundable payment.

The application is officially in process when ASTRO receives a completed facility agreement and HIPAA business associate agreement and all required fees.

If you have any questions regarding the application, please contact APEx Support.

Practices assess their compliance with APEx accreditation standards by completing the Web-based self-assessment tool and using the APEx Self-Assessment Guide, which provides a step-by-step process for completing the Self-Assessment. Practices submit their Self-Assessment, which includes Medical Records Review, Document Uploads of policies and procedures and Interview Preparation.

During the Self-Assessment, data obtained through Medical Records Review are derived from medical records chosen by the main facility. The information provided to ASTRO as a result of this Self-Assessment will not contain patient protected health information (PHI). The medical records chosen by the facility for the Self-Assessment must meet the following requirements: 

• Records must be pulled proportionate to the number of physicians in the practice (e.g., three physicians in practice with 300 patients per year, each physician should be represented by five medical records). 
• Diversity in modality must be present; Each modality the practice uses must be represented by a minimum of one record.

An interim report is issued identifying strengths and gaps in compliance with the standards.

Interim report. The facility will be provided with a detailed interim feedback report that identifies the extent to which the facility is in compliance with each of the APEx evaluation criteria and may indicate deficiencies that must be addressed in order to progress to the facility visit. Applicants are notified if they are ready to proceed for a facility visit or if they must complete a section of the Self-Assessment again. The facility will have time to correct deficiencies and has three (3) opportunities to pass each section of the Self-Assessment. In addition, if the interim report identifies new policies or processes that a facility must implement, the facility must demonstrate implementation, including that it has trained staff on the updated procedures. ASTRO will keep this report confidential and only share it with the facility itself or as specified in the APEx Procedures, unless otherwise required by law. A facility will be cleared for a facility visit when a facility demonstrates compliance with each element of the APEx Standards. The interim report is a preliminary indication of readiness for a facility visit; it is not a guarantee of accreditation.

If you have any questions regarding the self-assessment contact APExSupport@astro.org. 

ASTRO assigns a visiting team to conduct the facility visit. The team is selected from a list of names in the pool of approved surveyors who have undergone extensive APEx training. The team is selected based on:

• A conflict of interest review; 
• Geographic proximity to the facility (must be greater than 200 miles); and
• Expertise with the facility’s electronic health records (EHRs), treatment planning systems and modalities, among other considerations.

Prior to the facility visit, the surveyor team will have access to ROP’s APEx information, including the application (which describes the staffing, modalities, treatment planning system, electronic medical record system, etc.), and the document uploads from the Self-Assessment.

A facility visit preparation teleconference is conducted with the radiation oncology practice and ASTRO staff. The purpose of the teleconference is to discuss staff availability, equipment, changes to the application, facility expectations, HIPAA security policies and other logistical arrangements. 

ROPs are expected to provide the following resources during the facility visit: 

• Patient list by name and case identification numbers. 
• Access to medical records/paper charts. 
• Two computers per surveyor. (One computer is needed to access the electronic medical record and another for the Web-based electronic data entry platform). 
• Staff resource to guide the surveyor through the medical record. 
• Dedicated work space for the surveyor team. 
• Access to key staff for interviews.

Each survey team assigned to a single location practice, or the main facility of a multi-facility practice, will consist of two surveyors,one medical physicist and one radiation oncologist. If needed, an additional member of the radiation oncology team will assist with larger main locations. This team will conduct an in-depth review at the main location that will last one business day. If an ROP has satellite facilities, an additional surveyor(s) will conduct expedited reviews of the Level 1 evidence indicators at the satellite facilities on the same day that the main location is reviewed. Survey team visits of the main and any satellite facilities are expected to be completed on the same business day.

An ROP applying for APEx accreditation can recieve full accreditation, provisional accreditation of a denial of accreditation. 

• Full accreditation: Full accreditation will be granted to an ROP that, in the exclusive judgement of ASTRO, meets the APEx Standards.
• Provisional accreditation: Provisional accreditation may be granted to an ROP that, in the exclusive judgement of ASTRO, does not meet the APEx Standards, but for which ASTRO believes there is a reasonable expectation that they will be met within a forseeable period of time from the date of the intial facility visit. A provisionally accredited ROP will be required to satisfy specification of a Corrective Action Plan (CAP) within an established time frame in order to be granted full accreditation.
• Denial of Accreditation: ROPs that are determined not to meet the requirements of the APEx Standards are denied accreditation. This includes provisionally accreditated ROPs that do not satisfy the specifications of their CAP within the pre-determined timeframe.