What is the difference between a clarification question (or comment) and a formal inquiry?

Throughout the preview period, facilities will be able to submit clarification questions and comments. A clarification question is any question about methodology or how scores are calculated. This includes a request for a patient list. The purpose of a clarification question is to allow a facility to obtain more information about its score calculation. If a facility believes it has identified an error in its score, it may submit a single formal inquiry requesting CMS review. A formal inquiry is an explanation from a facility about policy or methods and/or a request to change a measure score based on evidence (typically a review of patient-level data). Facilities must indicate approval of the Medical Director/Facility Administrator when they submit their formal inquiry. CMS will respond to all formal inquiries submitted during the preview period (although CMS may send the response after the Preview Period ends).

Although each facility is permitted to submit only one formal inquiry, facilities are not limited in the number of clarification questions and comments they submit. If clarification questions are submitted after the midpoint of the preview period, however, then CMS may not be able to resolve all of the facility’s questions with sufficient time for the facility to submit a formal inquiry, if desired. Formal inquiries and questions will not be accepted after the end of the preview period.

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