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.
The intent behind the high cost/high utilization category is that the practice is actively measuring the total cost of services or how much utilization occurs. A diagnosis of a condition may not be used as a proxy for high cost/high utilization. For instance, measuring the number of patients with uncontrolled asthma would not count under high cost/high utilization, but if those patients have multiple ER visits per year, this would be considered high utilization.
PCMH
No, organization or health system involvement in a benchmarked/ performance-based recognition program will not meet. For KM 13, the practice must participate in an external recognition program that assesses the practice or clinician-level performance, using a common set of specifications to benchmark results. The external recognition program should also publicly report results and have a process to validate measure integrity.
PCMH 2017
No, connection to an HIE or RHIO alone would not meet the intent of TC 03. A PCMH collaborative activity must be external to practice, involve multiple practices, be ongoing (not a short-term activity), cover multiple aspects of patient-centered care, and involve some level of collaboration between practices to learn and share best practices with their peers. Connection to an HIE or RHIO may help the practice meet elective criterion CC21A.
PCMH 2017
To meet criterion QI 11 a practice must first establish a baseline for a patient experience measure and then set goals and take actions to improve upon this measure. Qualitative measures can be used if the qualitative feedback can be measured and the baseline can be compared to any improvement. An example of this may be the practice trying to reduce the total number of negative feedback responses they receive through a suggestion box pertaining to wait times by 50%.
PCMH 2017
If a PA or an APRN shares a panel of patients with a physician then that team would be considered a solo site since all patients are assigned to the primary provider with a single panel.
If the PA or APRNs that have their own panel of patients and can be selected as a patient’s primary care clinician, the site would not be considered a solo site.
PCMH 2017
No, because of limitations in IDSS organizations must report all indicators of a hybrid measure using the same year of data. For example, if the audited HEDIS 2019 hybrid data are being reported for CDC, then all indicators in CDC must be reported using audited HEDIS 2019 hybrid data. You may not just report audited HEDIS 2019 data for one indicator. This also applies to measures like WCC, COA, CDC and TRC.
HEDIS 2020
Yes. NCQA posted guidance for HEDIS reporting and Accreditation/Recognition programs at https://www.ncqa.org/covid/. NCQA is monitoring the effects of the coronavirus on our customers; we will adjust requirements as circumstances warrant. Please continue to check this website frequently as the situation continues to evolve.
UM-CR-PN 2020
