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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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2.16.2013 Care for Older Adults For the functional status assessment indicator, the fourth bullet requires notation of at least three of the four components: cognitive status, ambulation status, sensory ability and other functional independence. For "sensory ability," must all three components (hearing, vision, speech) be documented to meet the criterion?

Yes. All three components must be evaluated to fulfill the sensory ability component.

HEDIS 2013

2.16.2013 Adult BMI Assessment May a member's weight and BMI be noted on different dates of service in the medical record?

Yes. Weight and BMI may be noted on different dates of service as long as they are documented in the medical record during the measurement year or year prior to the measurement year.

HEDIS 2013

2.16.2013 Meaningful Use of Health IT Domain I was sent an email with log-in instructions for accessing the MUHIT survey, but I am not the contact at my organization who will be filling out the survey. Can you assign the survey to someone else in my PO?

We have assigned one contact per PO to the MUHIT survey, and that person may add as many users as necessary to the survey. Instructions for adding users to the survey are as follows:

  • Go to the Manage User tab
  • Select Add User
  • Select Create a User
  • Enter email address of the person from your PO you want to add
  • Create a password. If the contact you are adding already has access to the P4P PO reports, they will use the same password.
  • Assign one of the following two roles: Administrators: Manages users, fills out the survey, submits the survey; Assessors: Fills out the survey.

2.16.2013 General Guidelines If an organization finds an undated lab result in a progress note, can the progress note date be used as the lab result date?

No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.

HEDIS 2013

2.16.2013 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents If height and weight are documented in the medical record during the measurement year, may the organization calculate BMI percentile at a later date?

Yes. The BMI percentile may be calculated by the organization at a later date. It must be calculated and documented in the medical record during the measurement year to be eligible for use in HEDIS reporting.

HEDIS 2013

2.16.2013 Meaningful Use of Health IT Domain Documentation is required for 5% of PCPs/EPs reported as using certified software, with documentation for a minimum of 2 and a maximum of 5 PCPs/EPs. Does this mean we need to provide documentation for 5 different PCPs for each measure?

No. Documentation is required for 5% of PCPs/EPs reported as using certified software, but the same PCP/EP may be used for every measure. For example, the following scenarios are acceptable documentation:

  • The PO has a global report for all PCPs/EPs for all 20 MUHIT measures. This report would be the only documentation required for Measures 1-20; the PO would simply need to attach this report to the survey and associate the same document with each measure.
  • The PO has dashboard reports for individual PCPs/EPs, for all 20 MUHIT measures. If the PO has 60 PCPs on certified software, 5% of those 60, or 3 PCPs are required to have documentation. The PO may attach the dashboard reports, which detail all 20 MUHIT measures including threshold requirements, for 3 PCPs, and associate those three documents with each measure. There is no need to pick 3 separate PCPs for each measure.
  • If the PO has access to the CMS attestation reports, these may be used as documentation for Measures 1-15. If the PO reports 60 PCPs/EPs on certified software, the PO may attach the CMS attestations for 3 PCPs (5% of the 60), and associate the three CMS attestations with each of Measures 1-15. Separate documentation may be required for the CMS menu items, if they are not specified in the CMS attestation.

2.15.2013 Eligibility for accreditation prior to establishing relationships Is an organization eligible for accreditation if it does not perform the functions specified within the standards and guidelines directly and has not entered into an effective service agreement with another entity to perform the function?

No. To be eligible the organization must perform the functions addressed in the Standards and Guidelines (e.g., QI, UM, CR, RR, and MEM, if applicable), either directly or through a service agreement. If the organization uses a service agreement, the agreement must specify functions covered and be effective before eligibility can be determined.

All other listed eligibility criteria also must be met.

2.15.2013 NA option for Medicare product line in Element B For QI 9 Element B, which requires organizations to adopt and distribute preventive health guidelines for perinatal care, care for children up to 24 months, care for children 2-19 years old, care for adults 2-64 years old and care for adults 65 years and older, is there an NA option for Medicare product lines that only serve individuals who are 65 years and older?

Yes. QI 9, Element B is NA for perinatal care, care for children up to 24 months, care for children 2-19 years old and care for adults 2-64 years of age for Medicare product lines that only serve individuals who are 65 years and older.

1.16.2013 Medical Record Review Validation What records are included in Group F (Exclusions)?

MRRV Group F (Exclusions) includes all optional and required exclusions and valid data errors found during medical record review. It does not include records excluded through administrative data or that belong to employees or their dependents. Other hybrid medical record exclusions that should not be reviewed in Group F are exclusions for CBP and the HbA1C Less Than 7% indicator. Because of the large volume, auditors review exclusion rates for these indicators separately. See the instructions in Volume 5, page 65 for reviewing CBP and HbA1c<7%.

HEDIS 2013

1.16.2013 Medical Record Review Validation Can auditors provide plans with the measures selected for over-read earlier than May 1? What if the plan finishes MRR earlier?

The current timeline says that the auditor selects the measures for review on May 1 and not before; however, if the auditor reviews the health plans internal timelines, and finds that the plan expects to finish MRR early, it is acceptable that the auditor send the measure list when all chart review is complete and he has received a final count of numerator hits for each hybrid measure. For example, if the plan finishes all chart chases on April 29 and provides the numerator count lists, the auditor can select the measures for validation and start the process early.

Note: If the auditor allows for an earlier MRRV timeline, the plan may have to adjust other deadlines affected by this change.

HEDIS 2013

1.16.2013 General Guidelines Should Medicare Advantage (MA) members who elect the hospice benefit and choose to remain enrolled in the MA plan be excluded from MA HEDIS denominators?

No, not for HEDIS 2013 reporting; however, beginning with HEDIS 2014, exclude MA members who elect the hospice benefit available through original Medicare. This change will be in the HEDIS 2014 Volume 2 specifications.

HEDIS 2013

1.16.2013 General Guidelines Can Health plans collect data from charts for a supplemental database and use the results for administrative rates?

Looking at charts is one way to collect data for a supplemental database (note: this activity should be distinguished from and not include chart review activities for the hybrid measures). All data in the supplement database, regardless of how it was collected, should be treated as administrative data. With the exception of standard data sources such as EHRs and state registries, supplemental databases should not be used during chart review for the hybrid measures.

HEDIS 2013