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 Use of patient experience data collected from external organizations Is the use of patient experience data considered part of the program in the following circumstances: 1. The organization incorporates third-party performance information data with its own and then takes action on it (i.e., integrates the third-party data with its own to develop a composite that it reports or uses as the basis of action, such as payment or network or benefit design) 2. The organization provides a link for members on a third-party site so the member can review that information?

For scenario 1, the data must be considered as part of the program being reviewed for PHQ because the organization has incorporated the data with its own or tailored the data and then used the data as a basis for its own action (e.g., reporting, payment or network or benefit design). For scenario 2, if _ as part of its program _ the organization simply provides a link to an external source of performance information on physicians without altering that data and represents it as such, and the organization does not take any action based on the data (e.g., pay any incentive or use data for network or benefit design) then it is not considered part of the program.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 Tools for readiness evaluations Is there a non-Web based tool available for our organization to use for self-assessment?

An organization can use the PDF version of the standards to assess readiness to undergo a survey, but in order to undergo a survey it must purchase and use the Web-based Interactive Survey System (ISS) Tool. To purchase the PDF version of the standards or the Survey Tool, visit the NCQA Web site (www.ncqa.org) or contact Customer Service at 888-275-7585.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 Credit for Performance-Based Designation Programs as Quality measures Does use of Performance-Based Designation programs _ such as NCQA, BTE Recognition programs and Meaningful Use count as quality measures?

Yes, refer to Appendix 4: Performance-Based Designation Programs for the level of credit received for each program.

This applies to the following Programs and Years:
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.

This applies to the following Programs and Years:
PHQ 2013

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.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 WHP Performance Measure Reporting What is the process for reporting performance measure results for Accredited With Performance Reporting (AWPR) status?

Organizations are responsible for reporting NCQA WHP performance measure results exactly as specified if they are seeking AWPR status. Organizations must submit performance measure results to NCQA and attain a score of 50% or higher on WHP 12, Element A.

In order to retain AWPR status, organizations must annually submit performance measure results. Organizations that are NCQA Accredited in Wellness and Health Promotion and want to upgrade to AWPR status must submit measure results by the next annual reporting date (April 15) in any year during the accreditation cycle.

Organizations typically complete the WHP Performance Measures Reporting Tool, an Excel workbook. They send the workbook to an NCQA-Certified Auditor to have their measure results audited before submission. The auditor completes the audit worksheet in the Reporting Tool and locks the workbook, the returns the workbook to the organization, which subsequently submits the tool to NCQA.

This applies to the following Programs and Years:
WHP 2013

11.15.2012 Certification for information providers May an information provider earn certification for the pieces it provides (e.g., standards, methodology, underlying data), while its customer (i.e., health plan that publishes the information) pursues other pieces (e.g., member communication and complaints, physician communication)?

No. PHQ consists of the specified certification options: Physician Quality (PQ), Hospital Quality (HQ), or both. Contact phq@ncqa.org to discuss your situation so we can consider additional survey options to meet market needs.

This applies to the following Programs and Years:
PHQ 2013

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?

At this time, there are no standardized (i.e., endorsed) measures of cost, resource use or utilization at the physician level.

This applies to the following Programs and Years:
PHQ 2013

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.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 Taking action on cost measures Is an organization prohibited from using cost efficiency if quality results are not available?

No. The organizations program must consider quality in conjunction with cost, resource use or utilization when taking action. However, if the organization is unable to identify standardized measures of quality for a particular specialty or if there is insufficient data on an individual physician, practice or group the organization can act on cost performance when quality performance is not known. This is allowed in order to maximize the availability of performance information but must be handled in a fully transparent manner so that it is very clear when a physician is designated as high value and when they are purely designated as low cost. Refer to the standards _ specifically the explanation in PQ1 D (on page 51) _ for further explanation.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 Following Standardized Measure Specifications Does a program have to use the most recent version of a measure to count it as a standardized measure in Element A?

Yes. The organization must follow the most current measure specifications from the measure steward, even if the NQF endorsement has not been updated.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 Frequency of re-measurement For plans using patient experience measures, must re-measurement occur every two years to meet Element E?

Yes. Plans that use patient experience measures must measure at least every two years to receive credit for this element.

This applies to the following Programs and Years:
PHQ 2013