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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4.16.2013 Adult BMI Assessment (ABA) The specifications state that ABA is the same measure as the CMS Stars measure Adult BMI assessment, which uses the HEDIS specification. The HEDIS specification defines continuous enrollment as the measurement year and the year prior, but the IHA specification defines continuous enrollment as only the measurement year. Which is the correct continuous enrollment?

The continuous enrollment should be the measurement year and the year prior to the measurement year. This will be corrected in the MY 2013 version of the P4P manual.

4.16.2013 Asthma Medication Ration (AMR) Table AMR-C includes the drug Indacteral, but this drug is not the final ASM-C NDC table. Should Indacteral be included in the measure?

No. Indacteral was removed from the ASM-C NDC list and noted in a Word document posted with the NDC lists on November 2, 2012. The medication was reviewed by the HEDIS Expert Pharmacy Panel and determined to be not indicated for asthma, so it was removed from the measure. The MY 2013 P4P manual will reflect this change.

4.16.2013 Diabetes Care (CDC) The following note appears to be listed under the Optimal Diabetes Care indicator for CDC: Additional exclusion criteria are required for this indicate that will results in a different eligible population from all other indicators. What are the additional criteria for the Optimal Diabetes Care indicator?

This footnote is meant to refer to the HbA1c<7% indicator; HbA1c<7% is the only CDC indicator that has a different eligible population from the other indicators. The footnote will be correctly placed in the MY2013 P4P Manual.

4.16.2013 Proportion of Days Covered (PDC) The specification requires a pharmacy benefit, but does not require a medical benefit. How do we identify and attribute members with only a pharmacy benefit?

Members with only a pharmacy benefit are not attributed to a PO, so they are not included in the measure.

4.15.2013 Delegating to an entity out of the country Does NCQA allow organizations to delegate to entities that are outside the United States and its territories?

Yes. Organizations may delegate to entities outside the United States and its territories; however, the operations of the client organization seeking accreditation or certification must be within the United States.

4.15.2013 Scoring for CR 2, Element C: Agreement and Collaboration with Health Plans How is CR 2, Element C scored for organizations that may not have a delegation agreement in place?

Element C is scored "NA" for organizations that do not have a delegation agreement, and there is no reporting to the client.

4.15.2013 Look-back period for delegation agreements and pre-delegation assessments of Interim Eos What is the look-back period for delegation agreements and predelegation evaluations for organizations coming through for Interim Surveys?

For Interim Surveys, the look-back period for delegation agreements and predelegation evaluations is 6 months.

4.15.2013 Scoring for CRC 2, Element C: Agreement and Collaboration with Health Plans How is CRC 2, Element C scored for organizations that may not have a delegation agreement in place?

Element C is scored "NA" for organizations that do not have a delegation agreement, and there is no reporting to the client.

UM-CR 2013

3.16.2013 Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART) In HEDIS 2013, Table ART-C includes code J3262, but P4P does not. Please confirm that it should be included.

Table ART-C should include J3262. This will be corrected in the next release of the P4P manual.

3.16.2013 Evidence-Based Cervical Screening (ECS) For Measurement Year 2012, would a member who had a Pap test and an HPV test on different dates of service in 2009 or 2008 fall in Rate 1 (Appropriately Screened) or in Rate 2 (Not Screened)?

The member would fall in Rate 2 (Not Screened) because the Pap test and the HPV test occurred on different dates of service.

3.16.2013 Encounter Rate by Service Type (ENRST) Table ENR-F in the Encounter Rate by Service Type measure has instructions to download codes from the CMS Web site, but the referenced file is no longer on the site. The instructions refer specifically to a spreadsheet titled Addendum AA-ASC Covered Surgical Procedures (ASC_AddAA.csv) for October 2012 from the site http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html

When I click the link, it brings up a download file named "asc-october2012-aa-bb-dd1-dd2-ee.zip," which has an excel spreadsheet and 5 txt files, ASC AA, ASC BB (and so on). Are these correct? Which should we use?

3.16.2013 General Guidelines I am a self-reporting PO who plans to submit results for Medicare members. Please clarify which health plans members I should include.

A self-reporting PO submits clinical results based on all Medicare members belonging to a participating health plan:

  • Anthem Blue Cross.
  • Blue Shield.
  • Health Net.
  • SCAN.
  • UnitedHealthcare.