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Payment Adjustments

General Information

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. 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 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.

During the preview period following the publication of the Preview PSR, a facility may ask clarification questions about how scores were calculated. If it believes an error has been made in the calculations or in the data used to determine the score, it may submit one formal inquiry to CMS outlining its concern(s). (The facility may submit as many clarification questions as needed.) CMS will address the single formal inquiry prior to finalizing that facility’s performance score and calculating the payment reduction percentage.

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