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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11.15.2012 HEDIS measures If we use HEDIS measures, will NCQA still look at code?

No. NCQA does not evaluate an organizations code; it reviews the organizations measure specifications and compares them to the original source specification (if applicable). Note that to be considered from a standardized source, the measure must be the version specified for the level measured; e.g. HEDIS physician level measures, not plan level measures.

PHQ 2013

11.15.2012 Eligibility for Case Management (CM) What organizations are eligible to pursue Case Management Accreditation?

NCQA considers entities that perform relevant functions to be eligible for NCQA CM Accreditation, including, but not limited to: CM organizations, population health management organizations, health plans (HP), managed behavioral healthcare organizations (MBHO), provider-based organizations– including medical groups, hospitals, integrated delivery systems, patient-centered medical homes (PCMH) and accountable care organizations (ACO), community care teams.

CM 2014

11.15.2012 Automatic credit for NQF endorsed surveys Does an organization that uses the NQF-endorsed CAHPS-CG survey receive automatic credit? If not, what is the organizations accountability for confirming factors in the measurement methodology?

An organization does not receive automatic credit for using CAHPS-CG for an NCQA Survey. For Element C, the organization must follow the aspects of the survey methodology outlined in the endorsed specification, and must specify how it will address all other aspects of methodology required by the element.

11.15.2012 Organizational accountability Are organizations responsible for confirming the factors in Element F, or is this the responsibility of an external vendor?

For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution,statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.

PHQ 2013

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 Collaborative data Must organizations include collaborative data for certification?

If the organization is seeking certification on a program that is part of a collaborative, those measures must be included.

PHQ 2013

11.15.2012 NA scoring for Renewal Surveys in QI 9 The 2013 edition of HP states that for QI 9, Element D, Performance Measurement, the look-back period for Renewal Surveys is NA. Is this correct?

Yes. QI 9, Element D is NA for Renewal Surveys for all factors. This is because organizations that undergo Renewal Surveys are already required to submit and are scored on preventive health HEDIS measures. Organizations undergoing Interim and First Survey options are not required to submit HEDIS measures.

11.15.2012 Requests for corrections or changes For PQ2: Elements B and C, how can patient experience of care data corrected, when this information is not disclosed to physicians?

The plan is not required to disclose member-specific results, nor is it expected that a physician can correct member responses. At a minimum, the physician must be given the methodology (e.g., sampling, attribution) and survey questions and, upon request, be allowed to confirm that the patients in the universe from which the sample was drawn are his or her patients, given the methodology.

PHQ 2013

11.15.2012 Publically Reporting Performance-Based Payments Element A. requires that the organization must publicly report information on the percentage of total payments based on performance. Does this require that the information be published or is it acceptable to make it available and notify customers that it is available?

For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution, statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.

PHQ 2013

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 Standardized Measure Specifications For Element A, if the organizations correction process allows elimination of non-compliant patients from the measure result at the request of the physician, even when those patients are in the standardized measure specification, is the measure still considered to be standardized?

No. To meet the definition of a standardized measure, the organization must follow the measure speciation exactly, including all numerator and denominator inclusions and exclusions.

PHQ 2013

11.15.2012 Patient experience measures Do the results of Patient Experience of Care surveys, using questions derived from CAHPS-CG, have a role in the evaluation of physician quality?

Yes. Patient experience measures are considered measures of quality. The organization may use items or composites from the CAHPS-CG survey. Measure specifications for the CAHPS-CG survey can be found on the AHRQ website (https://cahps.ahrq.gov/clinician_group/).

PHQ 2013