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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6.14.2018 CC 12 (Pediatric Specific) • AAP resource:

6.14.2018 KM 02F (Pediatric Specific) How do clinicians assess the pediatric patient's ability to interact with other kids in a normal fashion? If the child is functioning normally in school would that suffice?

A social-emotional screening tool would be the best route to assess this, and the recommendation is for that screening to be done on a regular basis.

PCMH 2017

6.14.2018 KM 12C (Pediatric Specific) Give examples of pediatric acute care services.

A reminder to schedule a follow-up visit related to an infection (e.g., otitis media, pharyngitis, urinary tract infection) or an injury (e.g., fracture, burn or cut requiring stitches) applies as an acute care service. 

PCMH 2017

5.29.2018 QI 06 Does the CAHPS PCMH Survey meet both QI 04 and QI 06?

The CAHPS PCMH Survey meets the requirement for QI 06 but only partially meets QI 04. The CAHPS PCMH Survey only meets the quantitative data requirement (QI 04A) for this criterion.  
 

Note: No modifications to the survey questions or length may be made. 

PCMH 2017

5.29.2018 CC 06 & CC 07 May a practice use credentialing information to meet CC 06 and CC 07?

No. Credentialing—although important to a clinician’s ability to practice—is not a specific indicator of performance or quality information. Practices must use performance data to evaluate the quality of specialists or consultants to whom they send patients. Performance data can be qualitative or quantitative and may be gathered from external reporting sources (e.g., PCSP recognition, CMS public reporting) or may be internal based on criteria defined by the practice (e.g., evaluating a specialist’s timeliness in returning referral reports, evaluating whether patients had a positive experience). 
 

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 CM 05 May practices make the individualized care plan available via patient portal, or are they required to provide the document in writing?

Although the care plan can be made available via the patient portal, it is essential that all patients have access to the document. If patients are not registered for the portal, they will not have access. In those cases, practices should use an alternative method to provide the written care plan to patients to ensure that all patients have access after an appointment. Please note practices must document that the care plan is provided to the patient in the patient’s medical record.
 

PCMH 2017

5.29.2018 CC 04C May practices use a “tickler file” for this item within CC 04?

No. The tracking system needs to include a record of both the order and receipt of results. A tickler system includes a copy of the order and is removed when results are received; it does not meet the requirement of the CC 04C because it does not maintain a record of receiving results.
 

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 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 QI 04A Are practices required to use the CAHPS PCMH survey to meet this requirement?

No. Practices may use any patient experience survey that includes questions related to three of the four categories specified in the standards (access; communication; coordination; whole-person care, self-management support and comprehensiveness).

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