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 Board certification and physician quality Will NCQA accept board certification, maintenance of certification and NCQA Recognition as markers of physician quality, or must there also be measurement of NQF markers?

Board certification alone does not count as a quality measure. The organization may take action based on physician completion of an ABMS or AOA board performance-based improvement module (generally, in conjunction with maintenance of certification) at least every two years. These activities may be used as a quality measurement activity to meet PQ 1 Element A. Under certain circumstances, the organization may use measures from other national or regional performance-based designation programs to satisfy some or all requirements for PQ 1, Element A. The organization must discuss this in advance with NCQA to determine if the designation program meets the criteria.

PHQ 2013

11.15.2012 Requests for corrections or changes For PQ2: Elements B and C, how can patient experience of care data corrected, when this information is not disclosed to physicians?

The plan is not required to disclose member-specific results, nor is it expected that a physician can correct member responses. At a minimum, the physician must be given the methodology (e.g., sampling, attribution) and survey questions and, upon request, be allowed to confirm that the patients in the universe from which the sample was drawn are his or her patients, given the methodology.

PHQ 2013

11.15.2012 Noncompliant patients and physician ratings Has NCQA made recommendations or looked at the effect of noncompliant patients on physician ratings?

Although patient factors such as noncompliance may affect measure performance rates, an integral role of the physician is to work continuously with patients to educate them on the importance of a specific process or meeting a specific target/goal.

PHQ 2013

11.15.2012 Cost, resource use or utilization measures Are there standardized measures for cost, resource use or utilization? If there are none, what measures are plans using?

At this time, there are no standardized (i.e., endorsed) measures of cost, resource use or utilization at the physician level.

PHQ 2013

11.15.2012 Collaborative data Must organizations include collaborative data for certification?

If the organization is seeking certification on a program that is part of a collaborative, those measures must be included.

PHQ 2013

11.15.2012 Survey Tool With PQ 2013 evaluating at the program level, are we required to purchase a tool for every certifiable entity, as in PHQ 2008?

No. An organization is required to purchase a separate survey tool for every program it brings forward. One program operated by an organization such as a corporate parent without variation from region to region may be surveyed using a single tool. An organization that brings forward more than one program must purchase and submit a separate tool for each discrete program it brings forward.

There is a pricing option for derivative programs a derivative program is defined as a program that shares common aspects (e.g. an organization uses the same measures and methodology for a single defined group of physicians but takes a different action (reporting vs. network tiering) as another program its organization brings forward for certification. NCQA can review common aspects once to streamline the survey process (thus the discounted price), although these are distinct programs. To receive a discount, the programs must be brought forward at the same time. Please see the pricing exhibit in the survey agreement. If you need additional information, please contact NCQA Customer Support at (888) 275-7585.

PHQ 2013

11.15.2012 Patient experience measures Do the results of Patient Experience of Care surveys, using questions derived from CAHPS-CG, have a role in the evaluation of physician quality?

Yes. Patient experience measures are considered measures of quality. The organization may use items or composites from the CAHPS-CG survey. Measure specifications for the CAHPS-CG survey can be found on the AHRQ website (https://cahps.ahrq.gov/clinician_group/).

PHQ 2013

11.15.2012 TDD/TYY requirements May organizations use State Relay services in lieu of offering TDD/TTY services?

Organizations may use State Relay services to meet the TDD/TTY requirement, but must be able to provide alternative phone numbers or services if members are not able reach 711 due to technology restrictions.

11.15.2012 Applications for PHQ surveys How long after NCQA receives an application for survey does the survey begin?

NCQA suggests that organizations submit an application for survey at least 180 calendar days in advance of the date requested for their Initial Survey, but preferably applications will be submitted further in advance. Organizations should indicate their preferred survey date and NCQA will accommodate them if possible.

PHQ 2013

11.15.2012 Defining "Taking Action" Is there a new definition of taking action in the 2013 PHQ Standards?

Yes. In prior versions of PHQ, NCQA required organizations to include all programs that met the definition of taking action in the survey, NCQA had a narrower definition. Because under PHQ 2013 organization chooses which programs to include or exclude in a PHQ survey, NCQA has broadened the definition so that if it chooses, an organization may opt to have programs certified that may not have been required under the prior PHQ.

For PHQ 2013, NCQA has defined taking action as: 1) Publicly reporting performance on quality or cost, resource use or utilization; 2) Using performance on quality or cost, resource-use or utilization measures as a basis for network design (such as tiering) or benefit design; 3) Using performance on quality or cost, resource-use or utilization measures to allocate rewards under a systematic, pay-for-performance program; 4) Reporting performance on quality, cost, resource use or utilization to physicians to support referral decisions.

If an organization is interested in certification for a program that includes actions not include an action defined above, it should contact NCQA to determine eligibility.

PHQ 2013

11.15.2012 Complaints The concept of "member complaints" pertains to health plans only, but not necessarily to Web sites or collaboratives. How does NCQA evaluate for those entities?

Though an organization may not have members in the way a health plan does, Web sites have users or consumers who might want to submit complaints (e.g., user complaints). Therefore, to meet the intent of Elements C and D, an organization must have policies and procedures to process, register and respond to consumer complaints; and must provide a documented process and evidence for how it handled those complaints.

PHQ 2013

11.15.2012 Attribution Do the NQF or HEDIS provider-level measurement specifications define attribution? For example, to whom to attribute performance: the diagnosing MD, prescribing MD, provider with most encounters and so on? If not, does this not result in variation?

Neither NQF nor HEDIS provider-level measures specifications require a specific attribution method, although HEDIS measures provide options for an organization to consider. While this might result in variation from one organization to another, there is currently no single industry standard method for attribution.

PHQ 2013