FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.

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11.15.2012 Methodology for evaluation of cost measures What constitutes an acceptable methodological approach to evaluation of cost?

NCQA does not prescribe the cost measures an organization selects, though it requires an organization to specify all aspects of its methodology (Element C). In addition, the organization must risk-adjust its measures (Element C, factor 8) and must meet the minimum statistical requirements for measurement error and measure reliability (PQ1 Element D, factor 2).

PHQ 2013

11.15.2012 Applicable factors for CM program If some factors are not applicable for our case management program, how would we address it to meet the requirements in CM 2, Element E: Initial Assessment?

For CM 2, Element E, which is a file review element, NCQA is looking for documentation of whether or not you completed the applicable activities listed in CM 2, Element D: Initial Assessment Process. For your program, you would note in your documentation that certain factors are not applicable for that particular patient population.

CM 2014

11.15.2012 Measure reliability If a plan demonstrates a different methodology for statistical validity, would the methodology be considered?

Element C, Define Methodology requires the organization to have a method for determining measurement error and measure reliability. Element D, Adhere to Key Principles sets requirements for minimum observations or levels of measure reliability or confidence intervalsas applicable for quality and cost, resource use or utilization measures. For calculating measure reliability for PHQ, the organization must use the method described in the Explanation in Element C under the subhead Measurement Error. Measure reliability is defined as the ratio of the variance between physicians to the variance within one physician, plus the variance between physicians. NCQA does not prescribe the method used to calculate confidence intervals because the appropriate method may vary based on the parameter (e.g., mean or proportion).

PHQ 2013

11.15.2012 NA scoring for Renewal Surveys in QI 9 The 2013 edition of HP states that for QI 9, Element D, Performance Measurement, the look-back period for Renewal Surveys is NA. Is this correct?

Yes. QI 9, Element D is NA for Renewal Surveys for all factors. This is because organizations that undergo Renewal Surveys are already required to submit and are scored on preventive health HEDIS measures. Organizations undergoing Interim and First Survey options are not required to submit HEDIS measures.

11.15.2012 Frequency of re-measurement For plans using patient experience measures, must re-measurement occur every two years to meet Element E?

Yes. Plans that use patient experience measures must measure at least every two years to receive credit for this element.

PHQ 2013

11.15.2012 Physician requests For PQ 2 Element C, could a collaborative manage the process?

Yes. PHQ requirements do not prohibit a collaborative from managing a request for corrections or changes made by physicians, but the organization remains accountable and responsible for responding to complaints from consumers and to requests for changes from physicians or hospitals based on actions taken by the organization.

PHQ 2013

11.15.2012 Pricing for Derivative Programs How does NCQA determine which pricing tier it places a derivative product in?

NCQA prices a program and any programs it qualifies as derivative programs using the pricing tier that includes the total number of physicians measured in all the programs an organization brings forward. No individual physician is counted more than once for the purposes of determining which pricing tier is used, but the total of all physicians in all programs determines the tier used for every program.

PHQ 2013

11.15.2012 Must-Pass: PQ 1 Element A Is PHQ 1, Element A a must-pass element? If so, is the change permanent?

PHQ 1, Element A is a must-pass element at the 50 percent scoring level; this is a permanent change.

PHQ 2013

11.15.2012 HEDIS measures If we use HEDIS measures, will NCQA still look at code?

No. NCQA does not evaluate an organizations code; it reviews the organizations measure specifications and compares them to the original source specification (if applicable). Note that to be considered from a standardized source, the measure must be the version specified for the level measured; e.g. HEDIS physician level measures, not plan level measures.

PHQ 2013

11.15.2012 Organizational accountability Are organizations responsible for confirming the factors in Element F, or is this the responsibility of an external vendor?

For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution,statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.

PHQ 2013

11.15.2012 Working with Physicians Our organization posts the results of our physician measurement program on our directory on January 1 and any tiered networks or differential benefits are effective that same date. We make the results available to members by request (e.g. the member can call an 800 number to ask about a physicians status in the tiered network) on December 1. Which date _ January 1 or December 1 _ does NCQA consider the action date for the purposes of calculating whether we notify physicians 45 days ahead of action and resolve requests for corrections or changes before taking action?

If information is available to the public–even if it is only available by request–NCQA considers this to be public reporting. Therefore, in this scenario the taking action date is December 1.

PHQ 2013

11.15.2012 Timing for Program Input In the Element B explanation under the head Feedback Timeframe requires the organization to seek feedback annually and Element C _ Program Impact requires the organization annually asses the program. Does the organization have to carry out these activities annually if its measurement cycle is every two years?

No. An organization that measures its physicians every two years can meet the requirement by seeking feedback and assessing the program every two years.

PHQ 2013