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.
NCQA does not evaluate coding accuracy and quality. Element D, Verifying Accuracy requires an organization to have a process to evaluate the accuracy of its measure results. The organization may use external auditors to verify its methodology, but is not required to do so. In the future, NCQA may develop standards for auditing physician measurement and a program for certifying auditors. With such standards, NCQA will consider making external audit a requirement.
In measuring physician performance and distinguishing among peers, the organization is required to specify minimum observations or denominators for each measure on which the action is based. Denominators are patient observations, which may include multiple observations for an individual.
Criteria must be defined at the level on which action will be taken.
Note: This applies if the organization uses minimum observations rather than confidence intervals or measure reliability.
NCQAs PHQ product was released in April 2006 as part of its Quality Plus Program, a voluntary suite of areas where NCQA-Accredited plans could earn distinction. NCQA Health Plan (formerly MCO) Accreditation standards do not include PHQ requirements.
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.
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 PHQ 1. Under certain circumstances, the organization may use measures from other national or regional performance-based designation programs to satisfy some or all requirements for PHQ 1, Element A. The organization must discuss this in advance with NCQA to determine if the designation program meets the criteria.
All measures on which an organization bases action are included in the scope of the PHQ Survey, including those that are developed and whose results are calculated as part of a collaborative. The exception is during the first year the standards are in effect (October 1, 2008_September 30, 2009). For surveys that start during that period, the organization may opt to carve out measures from a collaborative. The rationale for this exemption is two-fold. First, organizations will not need to wait until a collaborative undergoes a survey in order to have their own survey. Second, if the collaborative needs to make changes to any measures, methods or processes to meet the standard, it is not within the organizations control to make the changesalthough as a participant, it influences them. This allows time for the collaborative to make changes.
No. Survey prices apply to each discrete survey; NCQA does not apply credit forward to a future survey. Survey pricing reflects the amount and level of resources NCQA dedicates to evaluating an organization and at the time of the Full Certification Survey, NCQA must re-evaluate the organization on all requirements.
