All the last digits of "0" in the table should be replaced with "9" for the upper score. For example, Risk Group 1 should be revised so it is between 0.0000 and 0.2499. A score of 0.2495 should be assigned to group 1.
HEDIS 2013
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.
POs must attach either a global report produced by the EHR detailing the entire POs performance on each measure, or dashboard reports detailing the performance of individual PCPs. Reports are required for 5% of all PCPs reported as using certified software. Documentation is required for a minimum of two and a maximum of five PCPs. For example, if 60 PCPs are reported as using certified software, documentation will be required for 5% of the PCPs (3 PCPs). If 120 PCPs are reported as using certified software, however, documentation is only required for 5 PCPs. Although 5% of 120 is 6, the maximum number of PCPs for whom NCQA requires documentation is 5.
Yes. The Unknown category should be used in cases when the organization did not obtain race/ethnicity information using the direct or indirect data collection method or did not receive a "Decline" response. If the plan attempted to collect the information and the member gave a "Decline" response, the member is counted in the Direct Data Collection percentages (because the plan asked about the members race/ethnicity and received a response). The plan receives credit for attempting to collect the information, even though the member refused to provide it.
HEDIS 2013
No. The intent of the measure is to identify instances where a member received counseling for nutrition and physical activity; therefore, educational materials sent via mail or e-mail do not indicate that counseling occurred. The intent of including "member received educational materials" in the measure specifications is to allow for occasions where a provider gave educational materials to a patient during a face-to-face visit.
HEDIS 2013
Members who are in the denominator because of inaccurate claims data may meet the criteria for a valid data error. Valid data errors are identified only for hybrid measures during medical record review. If a member is in the denominator because of a claim with a code specified for the measure, the medical record must contain evidence that the member does not meet measure criteria; a silent chart is not evidence that the member does not have the condition being measured. If the valid data error criteria are met, the member should be removed from the sample and replaced with a member from the oversample.
Finding valid data errors is not intended to be a method of correcting improper billing practices, and they cannot be identified through supplemental data. Additional information and examples of valid data errors can be found in the Substituting Medical Records in the Guidelines for Calculations and Sampling (page 51).
HEDIS 2013
If there is evidence that the member remained in the nursing home or long-term care facility through December 1 of the measurement year, the discharge must be excluded from the denominator. If there is evidence that the member was discharged from the nursing home or long term care facility by December 1 of the measurement year, the discharge must be included in the denominator. Organizations may not assume that the member remained in a nursing home or long-term care facility through the end of the measurement year, based solely on the discharge status; there must be a method for identifying the members status for the remainder of the measurement year.
HEDIS 2013
An organization can use the PDF version of the standards to assess readiness to undergo a survey, but in order to undergo a survey it must purchase and use the Web-based Interactive Survey System (ISS) Tool. To purchase the PDF version of the standards or the Survey Tool, visit the NCQA Web site (www.ncqa.org) or contact Customer Service at 888-275-7585.
PHQ 2013
An organization does not receive automatic credit for using CAHPS-CG for an NCQA Survey. For Element C, the organization must follow the aspects of the survey methodology outlined in the endorsed specification, and must specify how it will address all other aspects of methodology required by the element.