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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3.16.2012 Diabetes Care (CDC) In the November 2011 release of the MY 2011 P4P specifications, Table CDC-A: Prescriptions to Identify Members With Diabetes does not match exactly with Table CDC-A in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In Table CDC-A: Prescriptions to Identify Members With Diabetes, in the row Miscellaneous antidiabetic agents, the drug Liraglutide should be included in the table.

This error will be corrected in the September 2012 release of the MY 2012 manual.

This applies to the following Programs and Years:

3.16.2012 Asthma Medication Ratio (AMR) In the November 2011 release of the MY 2011 P4P specifications, Table AMR-C: Asthma Medications does not match exactly with Table ASM-C in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In the Table AMR-C: Asthma Medications, in the row Inhaled steroid combinations the drug Bluticasone-salmeterol should read Fluticasone-salmeterol.

This error will be corrected in the September 2012 release of the MY 2012 manual.

This applies to the following Programs and Years:

3.16.2012 Diabetes Care Blood Pressure Control (<140/90 mm Hg) In the November 2011 release of the MY 2011 P4P specifications, Blood Pressure Control (<140/90 mm Hg) for Diabetes replaced exclusions with the note, The blood pressure reading must be in conjunction with an outpatient visit code or a nonacute inpatient visit code from Table CDC-C. This new note requires physician organizations to map blood pressure pulled from a registry to claim data to identify the specific visit codes. This change is extremely burdensome! Why was it necessary?

P4P made this change to align with HEDIS, but did not consider the unintended impact it will have on POs, which must pull the information from EHRs. Because of the burden to POs, P4P will revert to the prior language for this measure, outlined below.

When identifying the most recent BP reading noted during the measurement year, do not include BP readings that meet the following criteria.

BPs taken during an acute inpatient stay (Table CDC-O)

BPs taken during an ED visit (Table CDC-P)

BPs taken during an outpatient visit where a diagnostic test or surgical procedure was performed (e.g., sigmoidoscopy, removal of a mole) or BPs obtained the same day as a major diagnostic or surgical procedure (e.g., stress test, administration of IV contrast for a radiology procedure, endoscopy) (Table CDC-Q)

BP readings taken by the member.

This applies to the following Programs and Years:

3.16.2012 Asthma Medication Ratio (AMR) Based on the MY 2010 P4P Crosswalk to HEDIS 2011 NDC List document, P4P Table AMR-C crosswalks to the HEDIS table ASM-C for the NDC list, but long-acting inhaled beta-2 agonists are no longer included in Table AMR-C. Should they be used in the Asthma Medication Ratio measure for P4P?

No. Do not include long-acting inhaled beta-2 agonists when calculating the Asthma Medication Ratio measure.

This applies to the following Programs and Years:

3.16.2012 Appropriate Treatment for Children with Upper Respiratory Infection (URI) In the November 2011 release of the MY 2011 P4P specifications, Table URI-D: Antibiotic Medications does not match exactly with Table CWP-C in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In Table URI-D: Antibiotic Medications, in the row First generation cephalosporins, the drug Cephradine should not be in the table, in the row Macrolides the drug Erythromycin estolate should not be in the table, in the row Third generation cephalosporins, the drug Cefditoren should be included in the table. These errors will be corrected in the September 2012 release of the MY 2012 manual.

This applies to the following Programs and Years:

3.16.2012 Annual Monitoring for Patients on Persistent Medications (MPM) In the November 2011 release of the MY 2011 P4P specifications, Table MPM-A: Drugs to Identify Members on ACE Inhibitors or ARBs does not match exactly with Table CDC-L in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In the Table MPM-A: Drugs to Identify Members on ACE Inhibitors or ARBs, in the row Antihypertensive combinations the drugs Aliskiren-valsartan, Amlodipine-hydrochlorothiazide-valsartan, Amlodipine-hydrochlorothiazide-olmesartan and Amlodipine-telmisartan should be included in the table.

This error will be corrected in the September 2012 release of the MY 2012 manual.

This applies to the following Programs and Years:

3.16.2012 Chlamydia Screening in Women (CHL) In the November 2011 release of the MY 2011 P4P specifications, Table CHL-A: Prescriptions to Identify Contraceptives does not match exactly with Table CHL-A in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In Table CHL-A: Prescriptions to Identify Contraceptives,

in the row Contraceptives, the drugs Estradiol-medroxyprogesterone, Levonorgestrel, Medroxyprogesterone, and Norethindrone should be included in the table,

the drug Levonorgestrel-medroxyprogesterone should not be in the table.

These errors will be corrected in the September 2012 release of the MY 2012 manual.

This applies to the following Programs and Years:

3.16.2012 Avoidance of Antibiotic Treatment for Adults With Acute Bronchitis (AAB) In the November 2011 release of the MY 2011 P4P specifications, Table AAB-E: Antibiotic Medications does not match exactly with Table AAB-D in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In Table AAB-E: Antibiotic Medications,

the first two rows, 5-aminosalicylates and Amebicides should not be in the table,

in the row Aminoglycosides the drug Neomycin should not be in the table,

in the row First generation cephalosporins, the drug Cephradine should not be in the table,

in the row Miscellaneous antibiotics the drug Vancomycin should be included in the table,

the row sulfamethoxazole-trimethoprim DS should not be in the table,

in the row natural penicillins the drug Penicillin G benzathine should be included in the table,

in the row Third generation cephalosporins, the drugs Cefditoren and Cefpodoxime should be included in the table,

in the row Third generation cephalosporins, the drug Cefoperazone should not be in the table.

These errors will be corrected in the September 2012 release of the MY 2012 manual.

This applies to the following Programs and Years:

3.15.2012 Assessment against access standards If the organization-level assessment shows that established goals and thresholds were not met for access to appointments, must there be an additional assessment at the practitioner level?

Yes. If performance issues are identified through organization-wide analysis, the organization must perform an analysis at the practitioner level to identify the cause. Practitioner-level assessment may include the total population or a statistically valid sample.

This applies to the following Programs and Years:

3.15.2012 QI Work Plan Must the QI work plan address all the items listed under Work plan in the explanation to receive credit for QI 1, Element A, factor 9?

Yes. To receive credit for factor 9, the work plan must address all ten items listed Work Plan in the explanation.

This applies to the following Programs and Years:

3.15.2012 Cultural preference If an organization only assesses language and gender and matches member and practitioner based on linguistic and gender data, is this acceptable for QI 4, Element A, factor 1?

No. Organizations must assess members cultural, racial, ethnic and linguistic needs then take actions based on its findings. Leaving out one or more of the required assessment areas would not meet the intent of the element.

This applies to the following Programs and Years:

3.15.2012 Analysis of complaint and appeal data May organizations analyze complaint data by the five specified complaint categories and analyze appeal data by the type of procedures appealed?

No. While the organization may have different complaints and appeal category for business purposes, it must analyze and report both complaint and appeal data by the five specified categories for NCQA purposes. Even if the organization has no complaints or appeals in one or more reporting categories, it must still demonstrate its analysis and report the number of complaints and appeals for all five categories.

This applies to the following Programs and Years: