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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5.29.2018 CC 14 Are practices required to show they can identify all patients who have been admitted to the hospital and treated in the ED?

No. Practices are not required to identify all patients admitted to the hospital or ED, but they must have a process for identifying patients admitted to facilities used most often by their population. In addition to a documented process, practices must also submit a log or report demonstrating that patients were identified.

PCMH 2017

5.29.2018 CC 12 How do practices document co-management arrangements?

The practice must demonstrate at least three examples demonstrating co-management arrangements, such as de-identified referral forms that include the arrangements or sections of the medical record specifying the clinician responsible for each component of care. For example, for a diabetic patient who is referred to a medical oncologist, the arrangement would identify which clinician manages the diabetes and which clinician manages the side-effects of the oncology treatment and their expectation for timely sharing of patient information.

PCMH 2017

5.29.2018 QI 06 Are practices required to use an NCQA-Certified survey vendor to administer CAHPS PCMH?

No, practices are not required to use an NCQA-Certified survey vendor.

PCMH 2017

5.29.2018 CC 08 What is an example of an informal agreement?

An informal agreement could be a few sentences in a referral form, e-mail or other method of communication containing expectations for the specialist, including, but not limited to, the time frame for reporting to the primary care physician and specifying lab or test results that should be included in the report. This information is essential to clarify the relationship between the primary care provider and specialist.

PCMH 2017

5.29.2018 CC 21C How do practices demonstrate capability for electronic exchange of key clinical information with facilities?

There must be interconnectivity between the practice and facilities to exchange clinical information. The practice can demonstrate CC 21C via demonstration of the capability of the certified EHR to exchange clinical information.

PCMH 2017

5.29.2018 CC 01 What is the minimal information required to meet the requirements of the laboratory and radiology items outlined in CC 01?

There is no minimum data requirement. To meet this core requirement, practices must meet all six items outlined in CC 01. Practices must consider how best to demonstrate their process for each item to meet the intent as described in the guidance section of this criterion.

PCMH 2017

5.29.2018 CC 08 Are practices required to only refer to specialists with whom they have agreements, or is the requirement that an agreement be in place? Give an example of an agreement.

Practices are not restricted to referring patients only to practices with whom they have established agreements. NCQA reviews at least one example of a formal or informal agreement with a subset of specialists, but does not expect practices to have agreements with all specialists to whom they refer patients. The goal is that expectations are outlined in the agreement, in addition to expectations of timeliness/content of response from specialists.

PCMH 2017

5.29.2018 QI 11 May practices focus on improving results of a specific question in a patient experience survey?

Yes. Practices determine the area of patient experience on which to focus quality improvement efforts. This may be improvement of the results of a specific question on a survey, a section of a survey or the entire survey.

PCMH 2017

5.29.2018 QI 04 Can the practice choose to show reports from either quantitative data or qualitative data?

No. The practice needs to demonstrate that they collect both quantitative and qualitative data to meet the requirement.

PCMH 2017

5.29.2018 QI 08 May “improve performance” be a stated performance goal?

No. The performance goal must be quantified (e.g., a number or percentage signifying a specific performance level).

PCMH 2017

5.29.2018 QI 15 & QI 16 Is it acceptable to demonstrate only how reports from QI 01 are shared with staff, the public and patients?

No. Practices must provide an example of having shared at least one report from each of the following criterion in Competency A: QI 01, QI 02, and QI 04

5.29.2018 QI 15 May a practice with one clinician provide the same evidence for both clinicians and staff in QI 15?

Yes. Because the practice has only one clinician, practice-level data would be the same as clinician-level data, and therefore count for both.

PCMH 2017