FAQ Directory

A physician organization (PO) may select three definitions to use in determining the denominator for the MUHIT measures: the definition of “primary care practitioner,” or the CMS definition of “eligible professional” for Medicare or the CMS definition of “eligible professional” for Medicaid. All three definitions include physicians.

If a PO uses the “primary care practitioner” definition, it must include all physicians who are considered PCPs and are serving the commercial HMO/POS population. Because pediatricians serve as PCPs for children, they are included.

If a PO uses the CMS “eligible professional” definitions, all physicians serving the commercial HMO/POS population must be included. Because the focus of P4P is the commercial population, physicians are not required to have attested to CMS or the state for MU, to be included.

IHA 2013

The MY 2013 P4P Value Set Directory is correct. ICD-9-CM 91.46 and CPT 88155 were deleted from the Cervical Cytology value set and ICD-9-CM V76.47 was added to the Hysterectomy value set. These changes were not listed in the MY 2013 P4P Measure Updates.

IHA 2013

The Cervical Cancer Value Set was not included in the MY 2013 P4P Value Set Directory. The codes included in the Hypertension Value Set are:

• ICD-9-CM 180.0.
• ICD-9-CM 180.
• ICD-9-CM 180.1.
• ICD-9-CM 180.8.
• ICD-9-CM 180.9.
• ICD-9-CM 233.1.
• ICD-9-CM V10.41.

The other NCS Value Sets can be found by filtering for Value Set Name in the P4P Value Sets to Codes tab of the P4P VSD file. These Value Sets for NCS already exist as part of other measures. The Cervical Cancer Value Set will be included in the next release of the P4P Value Set Directory, which will also list the NCS measure separately.

IHA 2013

The 120-day rule should also apply to Rate 3, step 3 of the ECS measure. If there are multiple cervical cytology and HPV co-tests during the three or four years prior to the measurement year, and these occur within 120 days of each other, count only the first test.

IHA 2013

The delegation agreement between an organization and its delegate must: 1. Specify activities performed by the delegate in detailed language relative to applicable NCQA standard categories. 2. Specify functions not delegated, but retained by the organization. Organizations may include a general statement in the agreement addressing retained functions (e.g., the organization retains all other QI functions not specified in this agreement as the delegates responsibility). Existing agreements may be updated with an addendum or communication (e.g., e-mail, spreadsheet, table) between the organization and the delegate, indicating that responsibilities were mutually agreed upon before the delegation agreement was final and outlining the responsibilities of each entity.

Yes. Documentation of >99% or <1% may be used when reporting because an exact BMI percentile value is evident (i.e., 100% or 0%). These examples are not considered ranges or thresholds, which are not permitted when reporting the BMI percentile indicator. Examples of non-permitted ranges and thresholds are "75-80th percentile" and ">90th percentile" because the exact BMI percentile value is not evident.

HEDIS 2014

Yes. Exclude newborn care rendered from birth to discharge home from delivery before reporting Total Inpatient (step 3).

HEDIS 2014

Members with an “active” prescription for osteoporosis treatment (Table OMW-C) during the 365 days prior to the IESD meet the step 4 exclusion criterion. The prescription does not need to be dispensed during the 365-day look-back period. NCQA does not specify how long organizations must look back prior to the IESD to identify an “active” prescription; organizations determine the look-back period, which should be applied consistently across all members.

HEDIS 2014

Based on the current guideline, organizations should look for optional exclusions only where administrative data indicate that the specified numerator service or procedure did not occur. For the NCS measure, the optional exclusions indicate a justification for screening so it is not inappropriate care if these members are screened. Therefore, the optional exclusions in the NCS measure were intended to be required exclusions. In HEDIS 2015, these members must be removed from the eligible population regardless of numerator compliance. NCQA Measure Certification for NCS is based on the HEDIS 2014 optional exclusion guideline, test decks will not be updated until HEDIS 2015 and vendors may not recertify. Vendors who still need to certify NCS must comply with the current test decks. If an organization chooses to remove these optional exclusions from the NCS eligible population (i.e., treat them as required exclusions) for HEDIS 2014, the organization should work with their HEDIS Compliance Auditor to identify and remove these members.

NCQA Measure Certification for NCS is based on the HEDIS 2014 optional exclusion guideline, test decks will not be updated until HEDIS 2015 and vendors may not recertify. Vendors who still need to certify NCS must comply with the current test decks. If an organization chooses to remove these optional exclusions from the NCS eligible population (i.e., treat them as required exclusions) for HEDIS 2014, the organization should work with their HEDIS Compliance Auditor to identify and remove these members.

HEDIS 2014

There is an error in the percentage ranges listed in Table 1: MUHIT Points for ONC-ATCB Certified Software. The range to receive 4 points is 65_84.

IHA 2013

The Hypertension Value Set was not included in the MY 2013 P4P Value Directory. The codes included in the Hypertension Value Set are:

• ICD-9-CM 401.1.
• ICD-9-CM 401.
• ICD-9-CM 401.9.
• ICD-9-CM 401.0.

The Hypertension Value Set will be included in the next release of the P4P Value Set Directory.

IHA 2013

Yes. Step 1 of the ECS Administrative Specification Rate 1 should say, “…who had NO cervical cytology.”

This will be corrected in the next release of the manual.

IHA 2013