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.