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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2.16.2013 Care for Older Adults For the functional status assessment indicator, the fourth bullet requires notation of at least three of the four components: cognitive status, ambulation status, sensory ability and other functional independence. For "sensory ability," must all three components (hearing, vision, speech) be documented to meet the criterion?

Yes. All three components must be evaluated to fulfill the sensory ability component.

This applies to the following Programs and Years:
HEDIS 2013

2.16.2013 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents May a member's height, weight and BMI percentile be noted on different dates of service in the medical record for the BMI Percentile indicator?

Yes. Height, weight and BMI percentile may be noted on different dates of service as long as they are documented in the medical record during the measurement year.

This applies to the following Programs and Years:
HEDIS 2013

2.16.2013 Adult BMI Assessment May a member's weight and BMI be noted on different dates of service in the medical record?

Yes. Weight and BMI may be noted on different dates of service as long as they are documented in the medical record during the measurement year or year prior to the measurement year.

This applies to the following Programs and Years:
HEDIS 2013

2.16.2013 Adult BMI Assessment If the member's weight is documented in the medical record during the measurement year or year prior to the measurement year, may the organization calculate BMI at a later date?

Yes. The BMI may be calculated by the organization at a later date. It must be calculated and documented in the medical record during the measurement year or year prior to the measurement year to be eligible for use in HEDIS reporting.

This applies to the following Programs and Years:
HEDIS 2013

2.16.2013 Meaningful Use of Health IT Domain Documentation is required for 5% of PCPs/EPs reported as using certified software, with documentation for a minimum of 2 and a maximum of 5 PCPs/EPs. Does this mean we need to provide documentation for 5 different PCPs for each measure?

No. Documentation is required for 5% of PCPs/EPs reported as using certified software, but the same PCP/EP may be used for every measure. For example, the following scenarios are acceptable documentation:

  • The PO has a global report for all PCPs/EPs for all 20 MUHIT measures. This report would be the only documentation required for Measures 1-20; the PO would simply need to attach this report to the survey and associate the same document with each measure.
  • The PO has dashboard reports for individual PCPs/EPs, for all 20 MUHIT measures. If the PO has 60 PCPs on certified software, 5% of those 60, or 3 PCPs are required to have documentation. The PO may attach the dashboard reports, which detail all 20 MUHIT measures including threshold requirements, for 3 PCPs, and associate those three documents with each measure. There is no need to pick 3 separate PCPs for each measure.
  • If the PO has access to the CMS attestation reports, these may be used as documentation for Measures 1-15. If the PO reports 60 PCPs/EPs on certified software, the PO may attach the CMS attestations for 3 PCPs (5% of the 60), and associate the three CMS attestations with each of Measures 1-15. Separate documentation may be required for the CMS menu items, if they are not specified in the CMS attestation.

This applies to the following Programs and Years:

2.16.2013 Comprehensive Diabetes Care If no result is documented for an eye exam in the year prior to the measurement year, can the organization infer that the exam was negative for retinopathy?

No. Documentation of an eye exam that does not include a result does not count as a negative result and is not eligible for use in HEDIS reporting.

This applies to the following Programs and Years:
HEDIS 2013

2.16.2013 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents If height and weight are documented in the medical record during the measurement year, may the organization calculate BMI percentile at a later date?

Yes. The BMI percentile may be calculated by the organization at a later date. It must be calculated and documented in the medical record during the measurement year to be eligible for use in HEDIS reporting.

This applies to the following Programs and Years:
HEDIS 2013

2.16.2013 General Guidelines If an organization finds an undated lab result in a progress note, can the progress note date be used as the lab result date?

No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.

This applies to the following Programs and Years:
HEDIS 2013

2.15.2013 NA option for Medicare product line in Element B For QI 9 Element B, which requires organizations to adopt and distribute preventive health guidelines for perinatal care, care for children up to 24 months, care for children 2-19 years old, care for adults 2-64 years old and care for adults 65 years and older, is there an NA option for Medicare product lines that only serve individuals who are 65 years and older?

Yes. QI 9, Element B is NA for perinatal care, care for children up to 24 months, care for children 2-19 years old and care for adults 2-64 years of age for Medicare product lines that only serve individuals who are 65 years and older.

This applies to the following Programs and Years:

2.15.2013 Eligibility for accreditation prior to establishing relationships Is an organization eligible for accreditation if it does not perform the functions specified within the standards and guidelines directly and has not entered into an effective service agreement with another entity to perform the function?

No. To be eligible the organization must perform the functions addressed in the Standards and Guidelines (e.g., QI, UM, CR, RR, and MEM, if applicable), either directly or through a service agreement. If the organization uses a service agreement, the agreement must specify functions covered and be effective before eligibility can be determined.

All other listed eligibility criteria also must be met.

This applies to the following Programs and Years:

1.16.2013 Comprehensive Diabetes Care (CDC) Can CPT Category II code 4010F be used to identify ACE inhibitor/ARB therapy for the Medical Attention for Nephropathy indicator?

Yes. CPT Category II code 4010F (ACE inhibitor or ARB therapy prescribed or currently being taken) may be used to identify ACE inhibitor/ARB therapy (Table CDC-N) for the Medical Attention for Nephropathy indicator for P4P MY 2012. This code will be added to the MY 2013 manual.

This applies to the following Programs and Years:

1.16.2013 Medicare Measures in the P4P Manual The MY 2012 measure set document updated on December 6, 2012, does not include any Medicare measures, but Medicare measures are in the P4P manual. Why are the Medicare measures not listed in that document any longer?

The HEDIS-based Medicare Star measure results are collected, aggregated and reported at the PO level using the same process as for the commercial P4P program, but they are not part of the commercial P4P program and are not listed in the P4P measure set document. MA results will be publicly reported; health plans may choose to use the results as the basis for performance incentive payments, although no standard P4P program for MA currently exists.

This applies to the following Programs and Years: