Issue 2006-04, April 2006

Mammography Facility Certification File - Updated Procedures and Content

Provider Types Affected
Providers (facilities certified by the Food and Drug Administration (FDA)), who submit screening and diagnostic mammography claims to Medicare fiscal intermediaries (FIs) and to carriers

Key Points

• This article is related to CR4303. It provides guidelines for carriers/intermediaries to download the most recent Mammography Quality Standards Act (MQSA) file on a weekly basis and use it to adjudicate claims.
• Currently, the FDA file does not contain information on terminated facilities. The Centers for Medicare & Medicaid Services (CMS) will be populating a new file, however, with terminated facilities to enable carriers/intermediaries to pay for services prior to the date of termination and to deny services rendered after the date of termination.

Background
The Mammography Quality Standards Act (MQSA) ensures that all facilities that provide mammography services meet national quality standards.

The FDA, Center for Devices and Radiological Health, is responsible for collecting certificate fees and surveying mammography facilities (screening and diagnostic).

The FDA provides CMS with a file which contains a listing of all facilities that have been issued certificates to perform mammography services. CMS then provides the list to Medicare carriers and FIs, which also contains information about terminated facilities.

Additional Information
Section 104 of the Benefits Improvement and Protection Act (BIPA) of 2000, “Modernization of Screening Mammography Benefit,” provided new payment methodologies for both diagnostic and screening mammograms that utilize digital technology.

For Medicare to determine whether the mammography facility is certified to perform digital mammography (due a higher payment rate), the FDA sends an updated file via the CMS Mainframe Telecommunications System (CMSTS) on a weekly basis.

Effective July 1, 2006, CMS will be populating a new Mammography Quality Standards Act (MQSA) file with terminated FDA-certified facilities (designated with a “T” value). This will enable carriers/ intermediaries to pay for screening and diagnostic mammography services for terminated facilities prior to the date of termination and to deny services furnished after the date of termination. By doing so, it will enable the payment of claims that come into Medicare from a terminated facility if the date of service occurred before the facility was terminated.

Relevant Links
CR4303 is the official instruction issued to your FI or carrier, regarding this change. CR4303 may be found by going to http://www.cms.hhs.gov/Transmittals/downloads/R828CP.pdf on the CMS Web site.

Please refer to your local FI or carrier if you have questions about this issue. To find their toll-free phone number, go to http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

Pub. 100-4, Transmittal# R828CP, CR# 4303
Medlearn Matters Number: MM4303
Related CR Release Date: February 2, 2006
Effective Date: July 1, 2006
Implementation Date: July 3, 2006