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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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6.13.2022 When do I need to add additional information about the measure performance (PCSP AR 2022)?

Practices should submit an explanation when their performance falls below 80% for the following AR criteria:
•    AR-AC 1: Timely Clinical Advice by Telephone
•    AR-CC 4 (Option): Diagnostic Test Tracking (2 rates)

Practices should submit an explanation when their performance falls below 30% for the following AR criteria:
•    AR-CC 5: Secondary Referral Tracking

If the practice does not submit an explanation, NCQA will contact the practice and request context for their performance rates.

PCSP 2019

6.13.2022 Is there a minimum denominator requirement when reporting a rate for Annual Reporting?

No. There is no minimum denominator requirement. A sample of 30 (or more, because this increases the reliability of the sample) is expected to ensure statistical soundness, but there may be cases where it may be appropriate for the denominator to be <30. NCQA requests practices enter an explanation in the Notes from the Organization section in QPASS in this case.

If a practice reports a denominator <30 without a note, the evaluator may contact the practice to confirm data accuracy and to understand the data. The evaluation will be returned to the practice so they can enter an explanation in the Notes from the Organization section for the cited criteria.

 

PCSP 2019

6.13.2022 AR KM 01 For AR-KM 01: Medication Management (aligns with PCSP Transform KM 9), is a reported rate <80% automatically marked as “Not Met”? (PCSP AR 2022)

Yes. AR-KM 01 confirms that practices meet PCSP Transform KM 09, in which more than 80% compliance is required for medication lists. A rate less than or equal to 80% does not meet criteria.
 

PCSP 2019

6.13.2022 AR CC 04 For AR-CC 4: Diagnostic Test Tracking (aligns with PCSP Transform CC 5), must practices meet a percentage threshold to meet criteria? (PCSP AR 2022)

No. There is no percentage threshold for diagnostic test tracking measures. The expectation is that practices track all diagnostic tests routinely; if performance is lower than expected, the practice should enter the rationale for their low percentage in the Notes from the Organization section in QPASS.

For example, if data show a 30% return rate, that means 70% of the practice’s ordered tests never had a report returned to their PCP. 
 

PCSP 2019

6.13.2022 Is there a minimum threshold requirement when reporting a rate for Annual Reporting (PCSP AR 2022)?

It depends. If the AR requirement aligns with a PCSP criteria that explicitly specifies a threshold, then that value would be the minimum threshold. However, if a threshold is not explicitly stated in the criteria, then 80% or more is expected to ensure consistent application of the process. Please note that there may be some cases where it’s acceptable for the rate to fall below 80%. 

An explanation in the Note section of Q-PASS is required for practices that report a rate less than 80% for the following criteria: AR-AC 01 [Timely Clinical Advice by Telephone], AR-CC 04 [Tracking Lab Test Results], and AR-CC 05 [Tracking Imaging Test Results].

PCSP 2019

6.13.2022 For AR-KM 1: Medication Lists (aligns with PCMH KM 15), is a reported rate <80% automatically marked as “Not Met”? For AR-KM 1: Medication Lists (aligns with PCMH KM 15), is a reported rate <80% automatically marked as “Not Met”? (PCMH AR 2022)

Yes. AR-KM 1 confirms that practices meet PCMH KM 15, in which more than 80% compliance is required for medication lists. A rate less than or equal to 80% does not meet criteria.

PCMH 2017

6.13.2022 AR CC 4 For AR CC 4: Referral Tracking (aligns with PCMH CC 11), must practices meet a percentage threshold to meet criteria? (PCMH AR 2022)

No. There is no percentage threshold for referral tracking measures. The expectation is that practices track important referrals routinely; if performance is lower than expected, the practice should enter the rationale for their low percentage in the Notes from the Organization section in QPASS.

For example, if data show a 30% return rate, that means 70% of the practice’s referred patients never had a report returned to their PCP. 

PCMH 2017

5.24.2022 Updated: Boilerplate Language in Delegation Agreements for System Controls May organizations’ delegation agreements contain boilerplate language for system controls delegates?

Yes, if the language specifies that the delegate must meet NCQA requirements (UM 12, Elements A and C, factor 6; UM 13, Element C, factor 5; CR 1, Element C, factor 4; CR 8, Element C, factor 5), template language may be used in the delegation agreement. Language specific to each delegate is not required.

Note: The underlined text is a correction. The previous FAQ referred to the wrong element. 

HP 2022

5.16.2022 MY 2022 Technical Update – COL-E Measure In the updated version of the COL-E measure that was re-released in the MY 2022 Technical Update, the “Total” data element listed in the age column is not highlighted in Table COL-E-A-3: Data Elements for Colorectal Cancer Screening. Should this cell be highlighted?

Yes. The cell should be highlighted to indicate that it is calculated by IDSS.

HEDIS 2022

5.16.2022 Reducing the Sample for CIS for MY 2022 Reporting May organizations reduce the minimum required sample size for the Childhood Immunization Status measure when reporting MY 2022?

Yes. Disregard the “N” in Table 1. Organizations may reduce the sample size for the CIS measure using the prior year’s rate or the current year’s administrative rate.

**This FAQ applies to QRS MY 2022.

Exchange 2022

5.15.2022 System Control Requirements Review by Product Line If auditing is used to monitor an organization’s system controls or a delegate’s system controls, is sampling by product line required?

No. Sampling is not required by product line if the product lines are managed the same (a single system is used to manage all product lines).

HP 2022

5.15.2022 Delegation Oversight System Controls Monitoring - Audits Are both the organization and delegate required to conduct system controls audits for factor 5 in UM 13, Element C and CR 8, Element C?

Both the organization and delegate must monitor the delegate’s system security controls as part of the delegation oversight requirements and may choose audit as the monitoring method. If auditing is the chosen method, the delegate provides an audit report of modifications that did not comply with its policies and procedures or with the delegation agreement.

The organization is not required to conduct an audit if it determines that the delegate adequately monitored and reported noncompliant modifications, but must provide documentation (a report, meeting minutes or other evidence) that it reviewed and agreed with the delegate’s findings. If the organization determines that the delegate did not adequately monitor noncompliant modifications, it must conduct its own audit of the delegate’s system controls.

The organization must submit its documentation and the delegate’s documentation as part of the survey.
 

HP 2022