FAQ Directory

In the first scenario, the index date is 74 days prior to the end of the measurement period, so the member should be excluded. In the second scenario, the index date is 61 days prior to the end of the measurement period, so the member should be excluded.

For this exclusion, look back as far as possible in the members history.

In your example, the measurement period is 180 days (January 1_June 30). Step 2 of the numerator criteria reads, "within the measurement period, count the number of days the member was covered." In this case, look for covered days from January 1_June 30; in essence, the numerator is being capped. The PDC is not calculated by summing the days supply for pharmacy claims. You may need to set up a time array for each claim, to identify the time frame covered by each fill, then count the number of days in the measurement period that are covered by the time arrays. Thus, the numerator may not exceed the denominator for the person-level PDC calculation. Refer to the attached example for SAS code for arrays.

Yes, if the organization's documented process includes how it notifies practitioners that the information is available on the Internet; and if the organization informs practitioners where the information is located. If all practitioners do not have access to the portal, the organizations process must include how it notifies these practitioners of patient engagement.

Yes, although because MUHIT is scored at the measure level, PCPs might receive credit for some measures and not for others.

At least two prescriptions means that the patient had at least two pharmacy claims for a drug in the target class (this can be refills for the same drug). In the numerator, for a day to be covered, a patient must have a supply on hand of at least one drug in the class.

PDC measures are calculated through use of paid, nonreversed claims for target medications. If the drug claims dataset contains claim reversals (and paid claims that were reversed), analysts must ensure that the reversed claims are not used to calculate PDC. Claim reversals can be identified through multiple methods because there may be multiple fields in a drug claim that indicate whether it is a reversal. Many drug claims datasets have a Count field that contains a 1 for a paid claim and a -1 for a claim reversal. The dataset may also have a field called Reversal that contains a Y if the claim is a reversal claim, or an N if it is not a reversal. Reversal claims typically have a negative quantity and a negative cost.

The claim reversal (-1 in the Count field or Y in the Reversal field) may have a Claim Number that is identical to the original claim being reversed. If the Claim Number for the reversal claim is not identical to the Claim Number for the original claim, analysts can create coding logic that will identify the reversed claim as immediately preceding the claim reversal. This latter approach is not usually necessary because most drug claims datasets allow a claim reversal to be linked to an original claim.

Sixty days are covered. The first prescription lasts 30 days, starting January 1. If you move the next prescription's start date to the day after the previous fill has ended, it becomes January 31. The end date is March 1. In essence, the start date and the end date of the second prescription both move.

If an incentive is tied to completion of an HA as well as another activity, the incentive should be classified as Unknown for WHP 2012 reporting. Please note that example 4 in Table HAC-A was erroneously left in the specification for 2012; this example should be removed from the table.

No. An organization with Accredited status that does not meet the 80% scoring threshold for all performance measures retains its status, but will not receive AWPR status.

For PHQ 1 Element A, NCQA counts different indicators as separate measures if they reflect separate care processes; however, NCQA does not count different age stratification rates as separate measures For example, HbA1c testing and LDL-C screening count as two measures even though they are both part of Comprehensive Diabetes Care, but for Chlamydia Screening in Women, the two age stratifications and the total rate can only count as one measure.

It depends. Organizations with Accredited status will not lose that status. Organizations with AWPR status will be downgraded to Accredited status for conditions for which measures are not reported.