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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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
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
The definition of a program is clearly defined in Section 1 of the Policies and Procedures. A physician measurement program includes: 1) A defined group of physicians– the definition must include both physician type (e.g. specialty) and geographic area covered; 2) A defined set of clinical quality, service or patient experience measures– the program may also include a defined set of cost, resource use or utilization measures; 3) A defined methodology for producing measure results; 4) A specific action taken at a specific point in time based on the measure results.
A hospital transparency program includes: 1) A defined group of hospitals– the definition must include both hospital type and location; 2) A defined set of all-payer quality or cost measures whose results are publicly reported at a specific point in time.
Distinct programs are reviewed separately and a certification decision is issued for each. Physician measurement programs and hospital transparency programs are always distinct programs, even when operated by the same legal entity. NCQA reserves the right to determine that programs that are managed in a decentralized manner constitute distinct programs for review.
To the extent that one program is a derivative of another and share common aspects (e.g., an organization uses the same measures and methodology for a single defined physician group but takes two actions [reporting and network tiering]) and the organization seeks verification for both at the same time, NCQA can review common aspects once to streamline the survey process, although these are distinct programs.
PHQ 2013
No. Changing the referent time period materially alters the measure and would therefore not qualify as a standardized measure for Element A. Patient experience measures endorsed, developed or accepted by the NQF, AMA PCPI, national accreditors or government agencies may be used, but the organization must follow the measure or instrument specifications as written.
PHQ 2013
Required exclusions identify members who must be excluded from the measure, regardless of numerator compliance. They are listed as part of the eligible population criteria because members who meet the required exclusion criteria are removed when identifying the denominator of the measure. Optional exclusions should only be used to remove members that did not meet the measure's numerator criteria. Organizations may choose to apply optional exclusions, which are listed separately at the end of the measure specification, or may choose not to apply the exclusions.
HEDIS 2013
Yes, CPT Category II code 4010F (Angiotensin converting enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) therapy prescribed or currently being taken) can be used to identify ACE inhibitor/ARB therapy (Table CDC-K) for the Medical Attention for Nephropathy indicator for HEDIS 2014 reporting.
HEDIS 2013
