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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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11.15.2012 Measure reliability If a plan demonstrates a different methodology for statistical validity, would the methodology be considered?

Element C, Define Methodology requires the organization to have a method for determining measurement error and measure reliability. Element D, Adhere to Key Principles sets requirements for minimum observations or levels of measure reliability or confidence intervalsas applicable for quality and cost, resource use or utilization measures. For calculating measure reliability for PHQ, the organization must use the method described in the Explanation in Element C under the subhead Measurement Error. Measure reliability is defined as the ratio of the variance between physicians to the variance within one physician, plus the variance between physicians. NCQA does not prescribe the method used to calculate confidence intervals because the appropriate method may vary based on the parameter (e.g., mean or proportion).

PHQ 2013

11.15.2012 Standardized Measure Specifications For Element A, if the organizations correction process allows elimination of non-compliant patients from the measure result at the request of the physician, even when those patients are in the standardized measure specification, is the measure still considered to be standardized?

No. To meet the definition of a standardized measure, the organization must follow the measure speciation exactly, including all numerator and denominator inclusions and exclusions.

PHQ 2013

11.15.2012 Frequency of re-measurement For plans using patient experience measures, must re-measurement occur every two years to meet Element E?

Yes. Plans that use patient experience measures must measure at least every two years to receive credit for this element.

PHQ 2013

11.15.2012 Changing measure specifications With regard to patient experience measures, may we use items from CAHPS-CG but change the referent time period? For example, not rating the last 12 months, but rating the last visit and changing the response categories accordingly?

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

11.15.2012 Patient experience measures Do the results of Patient Experience of Care surveys, using questions derived from CAHPS-CG, have a role in the evaluation of physician quality?

Yes. Patient experience measures are considered measures of quality. The organization may use items or composites from the CAHPS-CG survey. Measure specifications for the CAHPS-CG survey can be found on the AHRQ website (https://cahps.ahrq.gov/clinician_group/).

PHQ 2013

11.15.2012 Applications for PHQ surveys How long after NCQA receives an application for survey does the survey begin?

NCQA suggests that organizations submit an application for survey at least 180 calendar days in advance of the date requested for their Initial Survey, but preferably applications will be submitted further in advance. Organizations should indicate their preferred survey date and NCQA will accommodate them if possible.

PHQ 2013

11.15.2012 Collaborative data Must organizations include collaborative data for certification?

If the organization is seeking certification on a program that is part of a collaborative, those measures must be included.

PHQ 2013

11.15.2012 Complaints The concept of "member complaints" pertains to health plans only, but not necessarily to Web sites or collaboratives. How does NCQA evaluate for those entities?

Though an organization may not have members in the way a health plan does, Web sites have users or consumers who might want to submit complaints (e.g., user complaints). Therefore, to meet the intent of Elements C and D, an organization must have policies and procedures to process, register and respond to consumer complaints; and must provide a documented process and evidence for how it handled those complaints.

PHQ 2013

10.16.2012 Comprehensive Diabetes Care Can CPT Category II code 4010F be used to identify ACE inhibitor/ARB therapy for the Medical Attention for Nephropathy indicator?

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

10.16.2012 General Guidelines What is the difference between "required" exclusions and "optional" exclusions?

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

10.15.2012 NHPs going through Full Survey after June 30, 2013. With the change to three Evaluation Options in 2013, what are New Health Plans required to do in their first Full Survey?

Beginning July 1, 2013 New Health Plans will be required to undergo the Renewal Evaluation Option in their first Full Survey. Prior to June 30, 2013, New Health Plan will undergo the Initial Survey as their first Full Survey. The look-back period for the survey will be 12 months.

10.15.2012 Basics What is the value of obtaining Case Management Accreditation?

Obtaining Case Management Accreditation serves as a self-evaluation for organizations to review their structures and processes as well as highlight the quality of their case management programs to entities that may contract with them.