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.

Filter Results
  • Save
  • Email
  • Print
expand all

5.29.2018 CC 12 How do practices document co-management arrangements?

The practice must demonstrate at least three examples demonstrating co-management arrangements, such as de-identified referral forms that include the arrangements or sections of the medical record specifying the clinician responsible for each component of care. For example, for a diabetic patient who is referred to a medical oncologist, the arrangement would identify which clinician manages the diabetes and which clinician manages the side-effects of the oncology treatment and their expectation for timely sharing of patient information.
 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 14 Are practices required to show they can identify all patients who have been admitted to the hospital and treated in the ED?

No. Practices are not required to identify all patients admitted to the hospital or ED, but they must have a process for identifying patients admitted to facilities used most often by their population. In addition to a documented process, practices must also submit a log or report demonstrating that patients were identified.
 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 14 Do hospitalization and ED visit data from the health plan meet the requirements of this criterion?

A practice may use health plan data to identify patients if it is provided at least weekly and if at least 75 percent of the patient population is represented by the health plan. The practice may use data from more than one health plan as long as the plans collectively represent at least 75 percent of the practice population.
 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 06 Is CAHPS a requirement for this measure?

No. Any standardized (non-proprietary) survey administered through measurement initiatives providing benchmark analysis external to the practice organization may be used to meet QI 06. Please note that the practice must administer the entire standardized survey (not just sections) so that it can be compared to available benchmarks.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 21C How do practices demonstrate capability for electronic exchange of key clinical information with facilities?

There must be interconnectivity between the practice and facilities to exchange clinical information. The practice can demonstrate CC 21C via demonstration of the capability of the certified EHR to exchange clinical information.
 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 11 May practices focus on improving results of a specific question in a patient experience survey?

Yes. Practices determine the area of patient experience on which to focus quality improvement efforts. This may be improvement of the results of a specific question on a survey, a section of a survey or the entire survey.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 05 How can practices stratify data for vulnerable populations?

Practices select a vulnerable population for measurement using fields that are available in their practice system. Practices may use categories such as race, age, ethnicity, language needs, education, income, type of insurance, disability or health status to identify specific populations that may experience disparities in care.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 04 Can the practice choose to show reports from either quantitative data or qualitative data?

No. The practice needs to demonstrate that they collect both quantitative and qualitative data to meet the requirement.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 15 & QI 16 Is it acceptable to demonstrate only how reports from QI 01 are shared with staff, the public and patients?

No. Practices must provide an example of having shared at least one report from each of the following criterion in Competency A: QI 01, QI 02, and QI 04

This applies to the following Programs and Years:

5.29.2018 CM 04 Does a clinical summary meet the requirement for a “plan of care”?

If the clinical summary also includes the details of the patient’s care plan (i.e., information outlined in the criterion guidance), then it would meet the requirement. A clinical summary alone that does not include the patient’s care plan information would not meet the requirement.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 15 May a practice with one clinician provide the same evidence for both clinicians and staff in QI 15?

Yes. Because the practice has only one clinician, practice-level data would be the same as clinician-level data, and therefore count for both.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 04C Our PCPs and specialists use the same integrated EHR. Do we need to show tracking and follow-up?

Yes. Practices that use integrated systems must demonstrate how specialists are notified of a referral request and how the referral status will be tracked (including the specialist’s report). Even if the same EHR is used by both the primary care practitioner and the specialist, evidence must clearly demonstrate how the requirements are met within the system.
 

This applies to the following Programs and Years:
PCMH 2017