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 Board certification and physician quality Will NCQA accept board certification, maintenance of certification and NCQA Recognition as markers of physician quality, or must there also be measurement of NQF markers?

Board certification alone does not count as a quality measure. The organization may take action based on physician completion of an ABMS or AOA board performance-based improvement module (generally, in conjunction with maintenance of certification) at least every two years. These activities may be used as a quality measurement activity to meet PQ 1 Element A. Under certain circumstances, the organization may use measures from other national or regional performance-based designation programs to satisfy some or all requirements for PQ 1, Element A. The organization must discuss this in advance with NCQA to determine if the designation program meets the criteria.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 Board Certification Does Board Certification status count as a quality measure?

No, Board Certification status alone does not count as a quality measure.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 Relative Resource Use (RRU) Measures Are HEDIS RRU measures appropriate for PQ 1 Element B?

No. HEDIS RRU measures are specified for assessment at the plan level, not for measurement of individual physician performance.

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

11.15.2012 Reapplying for certification When may an organization that fails to be certified reapply?

NCQA does not specify a minimum period after a denial during which an organization may undergo a new review, but the organization must have completed a new cycle of measurement and action in order for NCQA to review it against the standards.

This applies to the following Programs and Years:
PHQ 2013

11.15.2012 Requests for corrections or changes 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 Must-Pass: PQ 1 Element A Is PHQ 1, Element A a must-pass element? If so, is the change permanent?

PHQ 1, Element A is a must-pass element at the 50 percent scoring level; this is a permanent change.

This applies to the following Programs and Years:
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.

This applies to the following Programs and Years:
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/).

This applies to the following Programs and Years:
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.

This applies to the following Programs and Years:
PHQ 2013

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.

This applies to the following Programs and Years:
PHQ 2013

10.16.2012 Comprehensive Diabetes Care Can CPT Category II code 4010F be used to identify ACE inhibitor/ARB therapy for the Medical Attention for Nephropathy indicator?

Yes, CPT Category II code 4010F (Angiotensin converting enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) therapy prescribed or currently being taken) can be used to identify ACE inhibitor/ARB therapy (Table CDC-K) for the Medical Attention for Nephropathy indicator for HEDIS 2014 reporting.

This applies to the following Programs and Years:
HEDIS 2013