This system talks in initials, and the initials are load-bearing—a floor is not a target, a guideline is not a Condition, a performance year is not a payment year. Every term here is defined as this atlas uses it, with the plate it appears on and the source that stands behind it. When this atlas and a primary source disagree, the primary source wins. Always.
| TERM | SAID IN FULL | WHAT IT MEANS | WHERE IT APPEARS | WHAT STANDS BEHIND IT |
|---|---|---|---|---|
| Kt/V | clearance x time, divided by volume | The adequacy number—how much small-solute clearance a treatment delivered, scaled to the patient’s body water. Hemodialysis reads it per session as single-pool Kt/V (spKt/V); peritoneal dialysis reads it weekly, dialysis plus residual kidney function. One number, read three ways: a regulatory floor, a best-practice target, and an individualized goal. | The Two Ladders · The Draws · The Data Map · The Regulatory Year-Wheel | 42 CFR Part 494 (§§ 494.20-494.180) |
| spKt/V | single-pool Kt/V | The hemodialysis form of the adequacy number, read per session. The regulation sets the floor as a hemodialysis Kt/V of at least 1.2; it is the Measures Assessment Tool that specifies the single-pool calculation and the three-times-weekly schedule a surveyor scores against. | The Two Ladders | CMS ESRD Program Interpretive Guidance v1.1 (S&C-09-01, October 2008) |
| URR | urea reduction ratio | The older adequacy measure—the percentage drop in blood urea across a hemodialysis session. Part 494 names it exactly once, in the home-training standard, and sets no URR threshold; the 65 percent figure a surveyor works from lives in the Measures Assessment Tool and the QIP measure set, not in the regulation. | The Two Ladders | CMS ESRD Program Interpretive Guidance v1.1 (S&C-09-01, October 2008) |
| QIP | ESRD Quality Incentive Program | The pay-for-performance program that scores every facility and reduces its Medicare payment by up to 2 percent—0.5 percent for each 10 points below the minimum Total Performance Score. The performance year and the payment year are two different years. | The Border · The Accumulation · The Two Ladders · The Benchmark Pipeline · The Coverage Map · The Stakeholder Matrix · The Data Map · The Regulatory Year-Wheel · The landing dial | 42 CFR 413.178 |
| Total Performance Score | the TPS | A facility’s single QIP score for a payment year, built from the measure set in force for that year. It is the number the payment reduction is calculated from. | The Accumulation · The Benchmark Pipeline · The Data Map | ESRD Quality Incentive Program (CMS) |
| SMR / SHR / STrR | standardized mortality, hospitalization, and transfusion ratios | Claims-and-registry measures computed for each facility against a national expectation adjusted for its patient mix. STrR is how anemia came to be measured by its shadows after the ESA trials: not the hemoglobin, but the transfusions. | The Benchmark Pipeline · The Data Map | UM-KECC / Dialysis Facility Reports |
| MAT | Measures Assessment Tool | The surveyor’s scoring instrument inside the interpretive guidance—where a regulation’s requirement becomes a number a surveyor checks against a sampled chart. | The Two Ladders | CMS ESRD Program Interpretive Guidance v1.1 (S&C-09-01, October 2008) |
| QAPI | Quality Assessment and Performance Improvement | The facility’s own continuous internal monitoring program, required by 42 CFR 494.110. It is the one place in the machinery where the facility, not CMS, sets the review cadence. | The Border · The Crosswalk · The Benchmark Pipeline · The Data Map · The Regulatory Year-Wheel · The Map | 42 CFR Part 494 (§§ 494.20-494.180) |
| TERM | SAID IN FULL | WHAT IT MEANS | WHERE IT APPEARS | WHAT STANDS BEHIND IT |
|---|---|---|---|---|
| Conditions for Coverage | 42 CFR Part 494; often "the CfCs" | The federal conditions a dialysis facility must meet to bill Medicare. Not a license and not a guideline—the terms of payment. They are the spine this whole atlas is drawn on. | The Accumulation · The landing dial · The Map | 42 CFR Part 494 (§§ 494.20-494.180) |
| V-tag | the survey citation tags of the ESRD program | The numbered checkpoints a surveyor cites, each mapped to a piece of the Conditions for Coverage. Appendix H opens 377 of them, spanning V100 to V773; three more numbers appear in the guidance prose only as cross-references. CMS publishes no official total; the numbering leaves room. | The Map | State Operations Manual, Appendix H |
| Appendix H | State Operations Manual, Appendix H | Where the ESRD interpretive guidance and the survey protocol now live, relocated there by CMS memo QSO-26-09-ESRD in May 2026. It is the three-column join—tag, regulation, guidance—that this atlas draws as a connected view. | The Border · The Crosswalk · The Accumulation | State Operations Manual, Appendix H |
| Appendix Z / E-tag | the emergency-preparedness ledger | Emergency preparedness (494.62) is not scored in the V-series. It is surveyed under Appendix Z as E-tags—a different ledger, applied across every provider type, which is why it is drawn dashed on The Crosswalk. | The Crosswalk · The Accumulation | State Operations Manual, Appendix Z (Emergency Preparedness) |
| deemed status | accreditation in place of a State survey | The mechanism by which a CMS-approved accreditor’s survey stands in for the State agency’s. It is why a hospital-based unit can be surveyed as a hospital and never under Appendix H. | The Border | 42 CFR Part 488 |
| plans of correction | the facility’s answer to a citation | What a facility owes after a survey finds noncompliance: what will change, who owns it, and by when. It is the loop that closes the survey. | The Data Map | 42 CFR Part 488 |
| TERM | SAID IN FULL | WHAT IT MEANS | WHERE IT APPEARS | WHAT STANDS BEHIND IT |
|---|---|---|---|---|
| PPS | ESRD Prospective Payment System | The bundle. One case-mix-adjusted base rate per treatment covering the treatment, equipment, drugs, labs, supplies and capital—rather than a separate bill for each. The CY2026 base rate is $281.71. | The Border · The Accumulation · The Benchmark Pipeline · The Money Flow · The Coverage Map · The Regulatory Year-Wheel · The landing dial | CY2026 ESRD PPS Final Rule (CMS-1830-F) |
| case-mix | the per-claim adjusters | The multipliers applied to the base rate on each claim so that a sicker or costlier patient pays more than the average: patient case-mix, wage index, low-volume and rural, outlier, and the home-training add-on. | The Coverage Map | 42 CFR 413.234 |
| TDAPA | Transitional Drug Add-on Payment Adjustment | A temporary side door in the bundle for new renal drugs—paid outside the base rate for two years, then a post-TDAPA add-on for three more. Then the cliff: for a drug in an existing functional category, the base rate is not permanently raised. | The Accumulation · The Coverage Map · The landing dial | 42 CFR 413.234 |
| TPNIES | Transitional Add-on Payment for New and Innovative Equipment and Supplies | The other side door: 65 percent of the MAC-determined price for new equipment and supplies, for two years. For CY2026, zero items are approved. | The Accumulation · The Coverage Map · The landing dial | 42 CFR 413.236 |
| coordination period | the 30-month Medicare Secondary Payer window | When an employer group health plan is in place at the start of dialysis, that plan pays primary for 30 months and Medicare pays second. At month 31 Medicare flips to primary. This window is where the commercial cross-subsidy lives. | The Money Flow · The Coverage Map | 42 CFR 411.162 |
| MAC | Medicare Administrative Contractor | The regional contractor that actually processes a facility’s Medicare claims and sets the local price a TPNIES payment is calculated from. | The Regulatory Year-Wheel · The landing dial | Medicare Claims Processing Manual (Pub. 100-04), Chapter 8 |
| 72x | the ESRD type of bill | The institutional bill type for outpatient dialysis. The monthly 72x run to the MAC is the rhythm the billing ring of the year-wheel is drawn on. | The Regulatory Year-Wheel | Medicare Claims Processing Manual (Pub. 100-04), Chapter 8 |
| the Network withhold | how the ESRD Networks are funded | Fifty cents per hemodialysis treatment, adjusted for peritoneal dialysis, deducted from facility payment to fund the 18 ESRD Networks. Established by Public Law 99-509 (§9335) and codified at SSA §1881(b)(7). | The Accumulation · The Money Flow · The landing dial | Social Security Act § 1881(b)(7) |
| TERM | SAID IN FULL | WHAT IT MEANS | WHERE IT APPEARS | WHAT STANDS BEHIND IT |
|---|---|---|---|---|
| EQRS | ESRD Quality Reporting System | The CMS system facilities file into—admissions and discharges, the clinical monthlies, and the CMS-2728, 2744 and 2746 forms. Successor to CROWNWeb. Nearly everything downstream starts here. | The Border · The Benchmark Pipeline · The Stakeholder Matrix · The Data Map · The Regulatory Year-Wheel · The landing dial · The Map | CMS EQRS (End-Stage Renal Disease Quality Reporting System) |
| CMS-2728 | Medical Evidence Report | The form that registers a patient as having ESRD, filed within 45 days of the first outpatient treatment. It starts the Medicare entitlement clock and it is the front door to the national registry. | The Crossroads · The Border · The Stakeholder Matrix · The landing dial | CMS-2728 / CMS-2744 / CMS-2746 |
| CMS-2744 | Annual Facility Survey | The yearly facility census submitted to the Network—2744A for dialysis units, 2744B for transplant centers. | The Stakeholder Matrix · The Regulatory Year-Wheel · The landing dial | CMS-2728 / CMS-2744 / CMS-2746 |
| CMS-2746 | Death Notification | The form filed within 14 days of a patient’s death. No physician signature is required, and its cause categories are where withdrawal from dialysis is recorded. | The Crossroads · The Border · The Stakeholder Matrix · The landing dial | CMS-2728 / CMS-2744 / CMS-2746 |
| NHSN | National Healthcare Safety Network | The CDC’s infection-surveillance system. Dialysis Event reporting runs here, on its own quarterly deadlines—a separate path from EQRS, and the reason infection data has a different cadence from everything else. | The Stakeholder Matrix · The Data Map · The Regulatory Year-Wheel · The landing dial | CDC NHSN Dialysis Event Surveillance |
| UM-KECC | University of Michigan Kidney Epidemiology and Cost Center | CMS’s measure-development contractor. It takes EQRS and Medicare claims and computes the claims-based measures and the Dialysis Facility Reports. The NHSN-based measures are computed by CDC instead. | The Benchmark Pipeline · The Data Map · The landing dial | UM-KECC / Dialysis Facility Reports |
| Dialysis Facility Report | the DFR | The annual per-facility report UM-KECC produces. It is also presurvey reading: the surveyor may arrive having already read it. | The Accumulation · The Data Map | CMS S&C Letter 17-02 (ESRD Core Survey) |
| Care Compare | the public star rating | The consumer-facing CMS site where a facility’s measures become a star rating. It is the only output in the machinery aimed at patients rather than at the program. | The Stakeholder Matrix · The Data Map · The landing dial | Battelle—Partnership for Quality Measurement |
| USRDS | United States Renal Data System | The national ESRD research registry and its Annual Data Report. It runs roughly two years behind the present, which is why current-year questions cannot be answered from it. | The Money Flow · The Stakeholder Matrix · The Data Map · The Regulatory Year-Wheel · The landing dial | USRDS Annual Data Report (2025) |
| the ESRD Networks | 18 regional oversight bodies | The regional bodies that handle grievances, involuntary discharges, patient attribution and quality-improvement activity, funded by the treatment withhold and coordinated nationally. Established 1978 by Public Law 95-292. | The Accumulation · The Stakeholder Matrix · The landing dial · The Map | May 2026 ESRD Network contract awards |
| TERM | SAID IN FULL | WHAT IT MEANS | WHERE IT APPEARS | WHAT STANDS BEHIND IT |
|---|---|---|---|---|
| ESRD | end-stage renal disease | The administrative category, not only the clinical one: kidney failure requiring dialysis or transplant, and the status that opens Medicare entitlement at any age. The paperwork threshold and the clinical one are not the same moment. | The Crossroads · The Border · The Transplant Map · The Crosswalk · The Accumulation · The Two Ladders · The Benchmark Pipeline · The Draws · The Money Flow · The Coverage Map · The Stakeholder Matrix · The Data Map · The Regulatory Year-Wheel · The landing dial · The Map | Medicare.gov—ESRD entitlement pages |
| AKI | acute kidney injury | Kidney failure that may recover. Since 2017, an ESRD facility may treat AKI patients and be paid for it—a bridge opened by the Trade Preferences Extension Act of 2015. Recovery is the path off the map that the map has to leave room for. | The Crossroads · The Border | Trade Preferences Extension Act of 2015, sec. 808(a) |
| crash start | an unplanned start to dialysis | Beginning dialysis without preparation—typically inpatient, typically through a catheter, typically without a modality choice having been made. It is the worst way onto the map. | The Crossroads · The Border | The unplanned-start and AKI-recovery literature (four peer-reviewed studies) |
| PD | peritoneal dialysis | Dialysis across the patient’s own peritoneal membrane, done at home. Adequacy is read weekly rather than per session, and residual kidney function counts toward it. | The Two Ladders · The Draws | ISPD—prescribing high-quality, goal-directed peritoneal dialysis (Brown et al.) |
| KDOQI / KDIGO / ISPD | the guideline bodies | The professional guideline organizations whose targets sit above the regulatory floor. A guideline is not a Condition for Coverage: the floor is what a surveyor cites, the guideline is what good practice aims at. Confusing the two is the most common error in this whole machinery. | The Crossroads · The Two Ladders · The Benchmark Pipeline · The Draws · The Map | KDIGO and NKF-KDOQI (the guideline bodies) |
| KAS | Kidney Allocation System | The OPTN policy that decides who gets a deceased-donor kidney. Waiting time can be credited from the start of dialysis, which is backdated, or from a qualifying GFR—an asymmetry that matters to anyone counting their own time. | The Transplant Map | OPTN Policies, Policy 8.4.A—Waiting Time (Kidney Allocation System) |