ESRD Quality Incentive Program - Payment Adjustments
Guidance for explaining payment adjustments to each years Medicare reimbursements for healthcare providers.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 04, 2020
General Information
Medicare Improvements for Patients and Providers Act (MIPPA) directs the Secretary of HHS to develop a method to assess the quality of dialysis care provided by facilities, and to impose payment reductions in the event that a facility fails to meet established performance criteria. To receive full payment, facilities must meet or exceed a Total Performance Score set by CMS based on certain quality measures, which be found here (PDF). Facilities that fail to meet or exceed the Total Performance Score may receive a payment reduction of up to two percent. This payment reduction will apply to all Medicare payments to that facility in that payment year PY.
Once the data from a performance period are collected and compared to the applicable performance standard(s), an initial evaluation is made regarding each facility’s performance and the consequential payment reduction, if any. CMS communicates this finding to each facility by publishing individual Preview Performance Score Reports (PSRs). In these reports, CMS documents the facility’s performance in each of the various measures, illustrates their comparison to the applicable standard, and tallies the facility’s Total Performance Score.
Each facility's designated Point of Contact (POC) can log into ESRD QIP User Interface (UI) account via EQRS to download a facility Preview PSR or send inquiries. This preview period lasts 30 calendar days.
During the preview period following the availability of the Preview PSR, an inquiry process is available by which a facility may either ask questions about how scores were calculated or submit concerns. If it believes an error has been made in the calculations or data used to determine the score, the facility may submit as many inquires as needed. CMS will address the inquiry prior to finalizing that facility's performance score and calculating the payment reduction percentage.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.