If the vendor performs all functions (i.e., MEM 1: Health Appraisals), the written acknowledgment must state that the vendor performs all functions. If the vendor does not perform all functions, the acknowledgment must explicitly state the responsibilities of the vendor and those retained by the organization.
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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9.15.2015 Specificity of the Vendor Acknowledgment If an organization contracts with a vendor to meet NCQA requirements (e.g., MEM 1, MEM 2), how specific does the written vendor acknowledgment have to be?
9.15.2015 Acceptable Documents for Policies and Procedures Many scopes of review in the standards require policies and procedures. How does NCQA define “policies and procedures” and what are acceptable documents?
Policies and procedures are official documents that describe business rules and a course of actions, and the methods for carrying out the actions. Simply put, policies and procedures specify how an organization performs the requirement under review—the organization’s “documented process.”
Usually, NCQA expects the organization to present only the components of the policies and procedures that demonstrate it meets the requirement. Depending on the element, this may include, but is not limited to, a program description, operating guidelines or process flowchart.
UM-CR 2014
8.15.2015 Printed directory requirement in QI 12 Are printed directories required for QI 12, Elements A and B?
8.15.2015 Automatic credit for file review elements delegated to an NCQA-Accredited/Certified entity How is an organization scored for file review elements if the delegation agreement is signed just before survey submission?
The organization receives automatic credit for files selected from the NCQA Accredited/Certified delegate if the agreement is signed before survey submission and if all automatic credit requirements are met, as described in the delegation appendix, unless delegation is with an NCQA-Certified CVO. In that case, the organization receives automatic credit for verification, but files are reviewed for timeliness.
8.14.2015 General Guidelines Are members with a hospice benefit excluded from Medicare HEDIS reporting?
8.14.2015 General Guidelines Given the addition of the “Numerator events by supplemental data” data element, how will the reported rate be calculated?
The reported rate calculation is the sum of all numerator events by administrative data, medical record data and supplemental data, divided by the eligible population for administrative measures, or by the denominator for hybrid measures (i.e., reported rate = numerator events by administrative data + numerator events by medical record data + numerator events by supplemental data / eligible population or denominator).
HEDIS 2016
8.14.2015 General Guidelines For measures that require multiple events to meet criteria (e.g., CIS), how are the data classified if some events come from an administrative or medical record data source and some come from a supplemental database?
8.14.2015 General Guidelines Will the “Numerator events by supplemental data” data element be collected for all measures in Volume 2?
No. For HEDIS 2016 reporting, this new requirement was added to only the Effectiveness of Care (EOC) and EOC-like measures. “EOC-like measures” refers to the Utilization measures that have the same structure as and follow the same guidelines as the measures in the EOC domain (i.e., Frequency of Ongoing Prenatal Care, Well-Child Visits in the First 15 Months of Life, Well-Child visits in the Third, Fourth, Fifth and Sixth Years of Life, Adolescent Well-Care Visits). While supplemental data may be used for other measures, NCQA is not currently collecting this data element for other measures at this time.
HEDIS 2016
7.16.2015 General Guidelines Where can customers find additional information about Electronic Clinical Data Systems (ECDS) and the Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS) measure for HEDIS 2016?
7.15.2015 MA Deeming and the Medicare product line NCQA recently released a memo informing interested parties that it no longer offers the MA Deeming program. Can organizations with a Medicare product line still come through NCQA Accreditation?
6.29.2015 Controlling Blood Pressure for People with Hypertension (CBPH) Why are there are no codes that encompass the 140-149 BP range that is new for senior hypertensive patients (BP control for members 60-85: <150/90 mm HG)?
Unfortunately, the AMA has not released a CPT II code for a systolic reading of between 140 and 150 mmHg, or under 150 mmHg. We updated the CBPH measure to align with new blood pressure guidelines; if there are patients whose systolic reading falls between 140 and 150 and it is captured in other kinds of supplemental data, they can be included in the numerator. Our data suggests that use of CPT II codes to retrieve this data is uncommon. This data is available in EHRs as well as via supplemental sources such as registries and laboratory data. There is a note to this effect in the specification for the CBPH measure on page 50 of the manual (http://www.iha.org/pdfs_documents/p4p_california/MY-2014-VBP4P-Manual- 20141201.pdf).
This is similar to the way the HbA1C <8.0% is calculated, as there is not a CPT II code specific to <8.0%. More information can be found in the manual on page 66 (http://www.iha.org/pdfs_documents/p4p_california/MY-2014-VBP4P-Manual- 20141201.pdf).
IHA 2014
5.01.2015 Notifying NCQA of Reportable Events How and when must the organization notify NCQA of Reportable Events?
The organization must notify NCQA, in writing, within thirty (30) calendar days of the issuance of the notice of sanctions, issuance of a fine or issuance of a request for corrective action.
The organization must also complete an annual attestation signed by an officer, or other authorized signatory of the organization, affirming that it has notified NCQA of all Reportable Events specified within the Agreement. NCQA-accredited health plans that reports HEDIS results include the attestation with its submission of the annual IDSS attestation submission for HEDIS® reporting. Other health plans submit the completed attestation electronically to NCQA-Accreditation@ncqa.org.
CM 2014