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.

Filter Results
  • Save
  • Email
  • Print
expand all

5.29.2018 CC 04C Our PCPs and specialists use the same integrated EHR. Do we need to show tracking and follow-up?

Yes. Practices that use integrated systems must demonstrate how specialists are notified of a referral request and how the referral status will be tracked (including the specialist’s report). Even if the same EHR is used by both the primary care practitioner and the specialist, evidence must clearly demonstrate how the requirements are met within the system.
 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 12 How do practices document co-management arrangements?

The practice must demonstrate at least three examples demonstrating co-management arrangements, such as de-identified referral forms that include the arrangements or sections of the medical record specifying the clinician responsible for each component of care. For example, for a diabetic patient who is referred to a medical oncologist, the arrangement would identify which clinician manages the diabetes and which clinician manages the side-effects of the oncology treatment and their expectation for timely sharing of patient information.
 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 21C How do practices demonstrate capability for electronic exchange of key clinical information with facilities?

There must be interconnectivity between the practice and facilities to exchange clinical information. The practice can demonstrate CC 21C via demonstration of the capability of the certified EHR to exchange clinical information.
 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 10 (PP 04) Our practice has agreements with and shares patient records with behavioral healthcare providers, but we do not share the same EHR or physical location. Do we meet the requirement for integrating behavioral healthcare in our practice?

No. Although there is no requirement for a behavioral healthcare provider to be physically in the practice’s office, the behavioral healthcare provider must have at least partial access to the practice’s systems. Although the arrangements mentioned meet the intent of CC 09 (maintaining agreements with behavioral healthcare providers), they do not meet the requirements for this criterion. 

If a practice site in an organization has integrated behavioral healthcare, the other sites in the organization may receive credit if there is also a process for their patients to access those behavioral healthcare services.  

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 08 May “improve performance” be a stated performance goal?

No. The performance goal must be quantified (e.g., a number or percentage signifying a specific performance level).

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 14 Do hospitalization and ED visit data from the health plan meet the requirements of this criterion?

A practice may use health plan data to identify patients if it is provided at least weekly and if at least 75 percent of the patient population is represented by the health plan. The practice may use data from more than one health plan as long as the plans collectively represent at least 75 percent of the practice population.
 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 15 May a practice with one clinician provide the same evidence for both clinicians and staff in QI 15?

Yes. Because the practice has only one clinician, practice-level data would be the same as clinician-level data, and therefore count for both.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 06 Is CAHPS a requirement for this measure?

No. Any standardized (non-proprietary) survey administered through measurement initiatives providing benchmark analysis external to the practice organization may be used to meet QI 06. Please note that the practice must administer the entire standardized survey (not just sections) so that it can be compared to available benchmarks.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 11 May practices focus on improving results of a specific question in a patient experience survey?

Yes. Practices determine the area of patient experience on which to focus quality improvement efforts. This may be improvement of the results of a specific question on a survey, a section of a survey or the entire survey.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 04 Can the practice choose to show reports from either quantitative data or qualitative data?

No. The practice needs to demonstrate that they collect both quantitative and qualitative data to meet the requirement.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 04A How many patients are practices required to survey?

NCQA does not prescribe a sample size or frequency of surveying; however, the survey must represent the entire patient population and not focus on specific conditions or patient groups

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 15 & QI 16 Is it acceptable to demonstrate only how reports from QI 01 are shared with staff, the public and patients?

No. Practices must provide an example of having shared at least one report from each of the following criterion in Competency A: QI 01, QI 02, and QI 04

This applies to the following Programs and Years: