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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5.22.2018 AC 06 What are “alternative clinical encounters”?

“Alternative clinical encounters” are scheduled clinical encounters between patient and clinician in lieu of a traditional, one-on-one, in-person office visit; for example:

  • A scheduled telephone clinical visit.
  • A scheduled clinical video chat visit.

This applies to the following Programs and Years:
PCMH 2017

5.22.2018 AC 02 Are practices required to provide a minimum number of same-day appointments?

NCQA does not specify a minimum number of same-day appointments per day for practices, and not all clinicians must offer same-day appointments.

This applies to the following Programs and Years:
PCMH 2017

5.21.2018 TC 06 Our clinical staff teams are on different schedules, so they often meet in separate teams to discuss patients. Does this meet the requirement?

The requirement is met if teams share questions or concerns about shared patients via regular, structured communication (such as the EHR). The intent of the criterion is for all members of the care team to be involved in communication about patient care, but care teams can meet separately for each clinician’s scheduled patients.
 

This applies to the following Programs and Years:
PCMH 2017

5.21.2018 TC 08 What credentials are required for the care manager?

NCQA is not prescriptive regarding which clinical staff it is (clinician, nurse, social worker or other provider) and the practice may determine the training and skills needed to address and manage the behavioral health care needs of their patient population.
 

This applies to the following Programs and Years:
PCMH 2017

5.21.2018 TC 09 How can practices demonstrate that they provide access to evidence-based care?

Information about care can be provided to patients through materials such as brochures, flyers or information posted on the practice’s website. When describing the services provided by the practice, attention should be drawn to defining evidence-based guidelines for preventive and clinical care.
 

This applies to the following Programs and Years:
PCMH 2017

5.21.2018 TC 04 May patient/family/caregiver members of a practice’s advisory council participate in meetings by telephone?

Yes. This method of participation must be included in the practice’s documented process for involving patients/families/caregivers on QI teams or practice advisory councils.
 

This applies to the following Programs and Years:
PCMH 2017

5.21.2018 TC 01 Does the clinician lead and staff managing the medical home transformation need to be an MD?

The clinician lead of the medical home must be a clinician as defined in the PCMH Policies and Procedures, which includes clinicians with an unrestricted license as an MD, DO, APRN or PA; however, NCQA is not prescriptive regarding the staff member who can be designated as the PCMH manager. Both can serve multiple sites and both roles can be assumed by the same person.
 

This applies to the following Programs and Years:
PCMH 2017

5.21.2018 TC 09 Is a practice brochure sufficient evidence for this criterion?

This criterion requires both a documented process ensuring information is distributed to patients and demonstration of patient materials with the minimum information described in the guidance. However, if the practice's documented process is described in the patient brochure, that brochure could be sufficient evidence for TC 09.
 

This applies to the following Programs and Years:
PCMH 2017

5.21.2018 TC 06 Are practices required to have daily, structured meetings with the entire care team? Is the clinician required to attend?

TC 06 requires practices to engage in regular communication to discuss care for patients scheduled each day, but this requirement can be satisfied by demonstration of either scheduled team meetings or scheduled electronic team communication, depending on the practice’s process for communication. Please note this communication is focused on patient care needs and is not to discuss practice transformation activities or staffing schedules.
All members of the practice care team, including clinicians, must participate in the communication; however, it is not required that the clinician be present if the team meets in-person, as long as there is a process in place to communicate the information from the meeting to the clinician.
 

This applies to the following Programs and Years:
PCMH 2017

5.15.2018 ECDS Do you utilize FHIR to specify ECDS measures?

No. HEDIS ECDS measures use Quality Data Model (QDM) 5.3 as the reference model, although NCQA is researching the use of FHIR as a possible option.  

This applies to the following Programs and Years:
HEDIS 2018

5.15.2018 ECDS What data standards does NCQA use to specify ECDS measures?

HEDIS ECDS measures use the Quality Data Model (QDM) and Clinical Quality Language (CQL) HL7 standards for quality measurement.

This applies to the following Programs and Years:
HEDIS 2018

5.15.2018 ECDS How do ECDS measures differ from the eMeasures in Meaningful Use (eCQMs)?

HEDIS ECDS measures are similar to eCQMs in structure, but although eCQMs are reported at the provider level, using data from an EHR, ECDS measures are reported at the health-plan level, using data from multiple sources to form a complete picture of the patient’s experience across the care continuum.

This applies to the following Programs and Years:
HEDIS 2018