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.

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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