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.
P4P made this change to align with HEDIS, but did not consider the unintended impact it will have on POs, which must pull the information from EHRs. Because of the burden to POs, P4P will revert to the prior language for this measure, outlined below.
When identifying the most recent BP reading noted during the measurement year, do not include BP readings that meet the following criteria.
BPs taken during an acute inpatient stay (Table CDC-O)
BPs taken during an ED visit (Table CDC-P)
BPs taken during an outpatient visit where a diagnostic test or surgical procedure was performed (e.g., sigmoidoscopy, removal of a mole) or BPs obtained the same day as a major diagnostic or surgical procedure (e.g., stress test, administration of IV contrast for a radiology procedure, endoscopy) (Table CDC-Q)
BP readings taken by the member.
There is an error in the manual. In Table CHL-A: Prescriptions to Identify Contraceptives,
in the row Contraceptives, the drugs Estradiol-medroxyprogesterone, Levonorgestrel, Medroxyprogesterone, and Norethindrone should be included in the table,
the drug Levonorgestrel-medroxyprogesterone should not be in the table.
These errors will be corrected in the September 2012 release of the MY 2012 manual.
The Index Prescription Date (IPD) should occur at least 91 days before the end of the measurement period, as stated in the definition of IPD. The Continuous Enrollment section should refer to the measurement period, for both self-reporting POs and for health plans.
This error will be corrected in the September 2012 release of the MY 2012 manual.
The file name has been updated on the CMS website. To reflect this change, the note under Table ENR-F should read as follow: * These codes can be found on the CMS Web site (http://www.cms.hhs.gov/ASCPayment/11_Addenda_Updates.asp#TopOfPage/). Click October 2011 ASC Approved HCPCS codes and Payment Rates. Use only the spreadsheet titled, Oct11_ASC_Add_AA-BB-DD1_ExtAct.xlsx, and the tab titled Oct11_ASC_AddAA-ExtAct. Only use 5-digit all-numeric CPT codes (Level 1 HCPCS) in the spreadsheet; do not include any codes with an alpha value. This update will be reflected in the September 2012 release of the MY 2012 manual.
There is an error in the manual. In Table AAB-E: Antibiotic Medications,
the first two rows, 5-aminosalicylates and Amebicides should not be in the table,
in the row Aminoglycosides the drug Neomycin should not be in the table,
in the row First generation cephalosporins, the drug Cephradine should not be in the table,
in the row Miscellaneous antibiotics the drug Vancomycin should be included in the table,
the row sulfamethoxazole-trimethoprim DS should not be in the table,
in the row natural penicillins the drug Penicillin G benzathine should be included in the table,
in the row Third generation cephalosporins, the drugs Cefditoren and Cefpodoxime should be included in the table,
in the row Third generation cephalosporins, the drug Cefoperazone should not be in the table.
These errors will be corrected in the September 2012 release of the MY 2012 manual.
There is an error in the manual. In the Table MPM-A: Drugs to Identify Members on ACE Inhibitors or ARBs, in the row Antihypertensive combinations the drugs Aliskiren-valsartan, Amlodipine-hydrochlorothiazide-valsartan, Amlodipine-hydrochlorothiazide-olmesartan and Amlodipine-telmisartan should be included in the table.
This error will be corrected in the September 2012 release of the MY 2012 manual.
There is an error in the manual. In Table CWP-C: Antibiotic Medications,
in the row First generation cephalosporins, the drug Cephradine should not be in the table,
in the row Macrolides the drug Erythromycin estolate should not be in the table,
in the row Third generation cephalosporins, the drug Cefditoren should be included in the table.
These errors will be corrected in the September 2012 release of the MY 2012 manual.
There is an error in the manual. The first date in the example should be November 30, 2010. The full example should read as follows:
For example, in the MY 2011 Breast Cancer Screening measure (which requires 2 years of continuous enrollment), a member who disenrolls on November 30, 2010 (the year prior to the measurement year), and re-enrolls on February 1, 2011 (the measurement year), is considered continuously enrolled as long as there were no other gaps in enrollment during either year. The member has one gap of 31 days (December 1_31) in 2010 and one gap of 31 days (January 1_31) in 2011.
This error will be corrected in the September 2012 release of the MY 2012 manual.
