Why is the performance period so much earlier than the year that this performance affects payment?

Facility performance data for the ESRD QIP is based primarily on claims data that dialysis facilities submit to CMS as part of their billing process. CMS requires six months after the end of the performance period to finalize these claims and to allow for corrections, appeals, and adjudication.

After all claims for services rendered during the performance period receive final adjudication, CMS analyzes the claims and calculates facility performance scores for the ESRD QIP. CMS then provides facilities with an opportunity to preview their scores and address any issues and concerns with CMS through a Preview Period. Upon completion of the Preview Period, CMS makes final adjustments to applicable payment reductions prior to the start of the payment year.

This entire process requires approximately one year from the end of the performance period to the time that payments are adjusted. As a result, the performance period must end at least a year before the beginning of the payment year.

End Stage Renal Disease

  1. Where can I find information from CMS regarding the Medicare program that ties payment to the quality of dialysis care?
  2. I have questions about the ESRD QIP. What should I do?
  3. What statute provides the legislative authority for the ESRD QIP?
  4. Where can I find the rules further explaining and outlining the ESRD QIP?
  5. Why is the performance period so much earlier than the year that this performance affects payment?
  6. How is a facility’s performance in the ESRD QIP communicated to the facility and the public?
  7. What are the inclusion criteria for the ESRD QIP?
  8. What is the Performance Score Report?
  9. What is the Preview Period?
  10. As a facility, what do I do if the provider numbers listed in my Preview PSR are wrong?
  11. What do I do if the data in my Preview PSR do not match the data I submitted?
  12. What is the difference between a clarification question (or comment) and a formal inquiry?
  13. Who can submit a clarification question about a facility’s Preview PSR?
  14. Who can submit a formal inquiry about the Total Performance Score on a facility’s Preview PSR?
  15. When does the Preview Period end?
  16. How do the ESRD QIP measures differ from the measures reported in the Dialysis Facility Compare Report?
  17. Why was a Total Performance Score not calculated for my facility?
  18. What is the Performance Score Certificate?
  19. What does the PSC mean to patients?
  20. When will facilities receive their PSC?
  21. When should facilities begin displaying the PSC?
  22. How long does a facility need to display the PSC?
  23. Are there any special instructions about displaying the PSC?
  24. What should a facility do if its PSC is lost or destroyed?
  25. Will the PSCs be available to patients and the public through other sources?
  26. Do the PSCs indicate the quality of care that a facility provides?
  27. Are home hemodialysis-only facilities included in the PY 2014 ESRD QIP?
  28. Are peritoneal dialysis-only facilities included in the PY 2014 ESRD QIP?
  29. Are pediatric-only facilities included in the PY 2014 ESRD QIP?
  30. For purposes of the program, on what date are facilities considered “new”?

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