If information is available to the public–even if it is only available by request–NCQA considers this to be public reporting. Therefore, in this scenario the taking action date is December 1.
PHQ 2013
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
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
- Email
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
- Print
Print this page.
Print this page.
11.15.2012 Working with Physicians Our organization posts the results of our physician measurement program on our directory on January 1 and any tiered networks or differential benefits are effective that same date. We make the results available to members by request (e.g. the member can call an 800 number to ask about a physicians status in the tiered network) on December 1. Which date _ January 1 or December 1 _ does NCQA consider the action date for the purposes of calculating whether we notify physicians 45 days ahead of action and resolve requests for corrections or changes before taking action?
11.15.2012 Cost, resource use or utilization measures Are there standardized measures for cost, resource use or utilization? If there are none, what measures are plans using?
11.15.2012 Timing for Program Input In the Element B explanation under the head Feedback Timeframe requires the organization to seek feedback annually and Element C _ Program Impact requires the organization annually asses the program. Does the organization have to carry out these activities annually if its measurement cycle is every two years?
11.15.2012 Pricing for Derivative Programs How does NCQA determine which pricing tier it places a derivative product in?
NCQA prices a program and any programs it qualifies as derivative programs using the pricing tier that includes the total number of physicians measured in all the programs an organization brings forward. No individual physician is counted more than once for the purposes of determining which pricing tier is used, but the total of all physicians in all programs determines the tier used for every program.
PHQ 2013
11.15.2012 Must-Pass: PQ 1 Element A Is PHQ 1, Element A a must-pass element? If so, is the change permanent?
11.15.2012 Physician requests For PQ 2 Element C, could a collaborative manage the process?
Yes. PHQ requirements do not prohibit a collaborative from managing a request for corrections or changes made by physicians, but the organization remains accountable and responsible for responding to complaints from consumers and to requests for changes from physicians or hospitals based on actions taken by the organization.
PHQ 2013
11.15.2012 Survey Tool With PQ 2013 evaluating at the program level, are we required to purchase a tool for every certifiable entity, as in PHQ 2008?
No. An organization is required to purchase a separate survey tool for every program it brings forward. One program operated by an organization such as a corporate parent without variation from region to region may be surveyed using a single tool. An organization that brings forward more than one program must purchase and submit a separate tool for each discrete program it brings forward.
There is a pricing option for derivative programs a derivative program is defined as a program that shares common aspects (e.g. an organization uses the same measures and methodology for a single defined group of physicians but takes a different action (reporting vs. network tiering) as another program its organization brings forward for certification. NCQA can review common aspects once to streamline the survey process (thus the discounted price), although these are distinct programs. To receive a discount, the programs must be brought forward at the same time. Please see the pricing exhibit in the survey agreement. If you need additional information, please contact NCQA Customer Support at (888) 275-7585.
PHQ 2013
11.15.2012 Noncompliant patients and physician ratings Has NCQA made recommendations or looked at the effect of noncompliant patients on physician ratings?
11.15.2012 Attribution Do the NQF or HEDIS provider-level measurement specifications define attribution? For example, to whom to attribute performance: the diagnosing MD, prescribing MD, provider with most encounters and so on? If not, does this not result in variation?
Neither NQF nor HEDIS provider-level measures specifications require a specific attribution method, although HEDIS measures provide options for an organization to consider. While this might result in variation from one organization to another, there is currently no single industry standard method for attribution.
PHQ 2013