FAQ Directory

Yes, replace Total Score LOINC Code “55758-7” with “89208-3” in the Depression screening instrument table for the Instruments for Adolescents (≤17 years), Beck Depression Inventory-Fast Screen (BDI-FS)®.

Exchange 2024

Yes, as described in the Required exclusions section of the CCS measure, use LOINC code 76689-9 to exclude members with a sex assigned at birth of male any time in the patient’s history. The code was mistakenly removed from the CCS measure in the 4-1-2024 release of the VSD (Direct Reference Code spreadsheet). Because the information needed for reporting is in the measure specification NCQA does not intend to reissue the VSD.

Exchange 2024

Yes, as described in the Required exclusions section of the CCS measure, use LOINC code 76689-9 to exclude members with a sex assigned at birth of male any time in the patient’s history. The code was mistakenly removed from the CCS measure in the 4-1-2024 release of the VSD (Direct Reference Code spreadsheet). Because the information needed for reporting is in the measure specification NCQA does not intend to reissue the VSD.

HEDIS 2024

When only a single code exists for a service or condition, it is included directly in the measure specification, and referred to as a Direct Reference Code (DRC). It is a best practice to not create value sets that include only a single code; some code systems prohibit this because it results in assigning another code (an OID) to a concept that already has a code.
DRCs are listed in the measure specifications and in a Direct Reference Codes spreadsheet in the value set directory.
For MY 2024, a number of single code value sets were converted to DRCs. The Summary of Changes – Value Sets spreadsheet indicates the value set was deleted. The Summary of Changes – Codes spreadsheet indicates the code was added as a DRC (filter Column A on “Direct Reference Code”).

Exchange 2024

The numerator criterion is an eGFR and a uACR any time during the measurement year. These separate tests may occur on different dates.
The 4-day proximity language is specific to a reporting option for uACR, where a quantitative urine albumin test and a urine creatinine test may be billed separately. In practice, the quantitative urine albumin and urine creatinine tests are performed on the same date, from the same urine sample, to produce a single ratio. The 4-day proximity language intends to account only for potential billing lags between the separate quantitative urine albumin and urine creatinine administrative codes that indicate a single uACR evaluation; it is not intended for separate samples from different dates.

HEDIS 2024

No. NCQA UM standards do not allow the use of AI to make medical necessity denial decisions, or any appeal decisions. 

If an organization uses AI in the UM process, medical necessity review requires that denial decisions be made only by an appropriate clinical professional and appeal decisions require same-or-similar specialist review, as specified in the NCQA standards.  

UM-CR-PN 2024

Any coded response (i.e., any non-null response—positive or negative) on a pre-specified instrument for food, housing and transportation counts for completed screening numerators (numerators 1, 3, 5). The PRAPARE Food Insecurity Instrument question (LOINC code 93031-3) is an exception. Based on how the question is structured and responses are coded, a “No” or “None of the above” response cannot be coded and must be left null. Therefore, a null response meets criteria for this item only. 

HEDIS 2024

No. If the medical record review retrieval and/or abstraction operations for HEDIS MY 2023 reporting of your organization were not impacted by the Change Healthcare cyberattack, then the timeline modifications do not apply to you. You must follow the HEDIS MY 2023 Audit Timeline published on NCQA.org.
Affected organizations (defined above) should work with their auditor on HEDIS MY 2023 timeline modifications. All HEDIS Compliance Audit Licensed Organizations will share this information with the relevant organizations.

HEDIS 2023

Battelle replaced NQF as the consensus-based entity for CMS; the Battelle Partnership for Quality Measurement (PQM) Submission Tool and Repository Measure Database can be found here: https://p4qm.org/. Organizations may only use measures classified as “Endorsed."

MBHO 2013

The request for provider sign-off stems from the ability to verify work has been reviewed by the eligible clinician, and not solely managed by another role within the organization—or externally.

An eligible provider must be able to provide evidence of their involvement in Care Management efforts. They should not be submitting care management efforts they have not directly reviewed. That said, we suggest provider’s sign-off on care plans to indicate that they have reviewed the care plans they are counting towards their CM efforts. 

If there is a systematic limitation–meaning an electronic system does not allow the provider to electronically sign-off on the care plan–an acceptable workaround would be to provide a relevant office visit note(s), a telephone communication note(s), etc. where the provider has documented that the care plan was reviewed, discussed, updated, etc. with the patient. 

Evidence provided should exemplify that the eligible clinician has had direct oversight in care management efforts for the patient. Care planning efforts may be facilitated by other parties within the practice, but the eligible clinician must be an involved participant in the care management efforts included in their CM reporting.

PCMH 2017

The expectation is that diversity data is collected from all patients in the practice. An overwhelming majority of the practice’s population should have diversity data on file. If this is not the case, the practice should annotate an implementation plan in the notes section of Q-PASS. This plan should include an expected timeline for improved performance.

Please note that diversity data should be collected directly from the patient/family/caregiver. Please refer to the Standards and Guidelines for acceptable response options for each aspect of diversity.
 

PCMH 2017

For AR-CM 1 (AR 2024), “total population” is defined as unique patients seen by the practice in the prior 12 months. The intent of this attestation is to provide a point of reference for the ratio of care managed patients to your practice-site’s total patient population.
 

PCMH 2017