Yes. Dashes are equivalent to $0.00.
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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12.16.2012 General Guidelines Some cells in the HEDIS 2013 Pharmacy Standard Pricing Table (SPT-Pharm) include dashes (-) instead of prices. Are the dashes equivalent to $0.00?
12.16.2012 Meaningful Use of Health IT Domain The Submitting the survey instructions in the Domain Structure of the Meaningful Use of Health IT domain specifications state that physician organizations must attach documentation for each measure, including documentation that thresholds for individual measures are being met. What kind of documentation is required, and how much?
POs must attach either a global report produced by the EHR detailing the entire POs performance on each measure, or dashboard reports detailing the performance of individual PCPs. Reports are required for 5% of all PCPs reported as using certified software. Documentation is required for a minimum of two and a maximum of five PCPs. For example, if 60 PCPs are reported as using certified software, documentation will be required for 5% of the PCPs (3 PCPs). If 120 PCPs are reported as using certified software, however, documentation is only required for 5 PCPs. Although 5% of 120 is 6, the maximum number of PCPs for whom NCQA requires documentation is 5.
This applies to the following Programs and Years:
12.16.2012 Osteoporosis Management in Women Who Had a Fracture (OMW) When determining the eligible population for the OMW measure, access to inpatient claim/encounter data is necessary if a member had a fracture requiring an inpatient stays. Specifically, the inpatient claim/encounter data are required to calculate admission and discharge dates. Many self reporting POs are not at risk for inpatient stays and as such we do not have access to inpatient claim/encounter data. How are we suppose properly calculate the eligible population if we do not have inpatient claim/encounter data?
Physician organizations that do not have access to inpatient claim/encounter data may use professional claims indicating that a physician saw the member in the hospital, as a proxy. In this scenario, the physician organization uses the physicians first visit with the member as a proxy for the admission date and uses the last visit as a proxy for the discharge date. This alternative method may be used only by physician organizations that do not have access to inpatient claim/encounter data.
This applies to the following Programs and Years:
12.16.2012 Annual Monitoring for Patients on Persistent Medications (MPM) The Measure Updates section for MPM states that LOINC code 62425-4 was added to Table MPM-B, but in Table MPM-B LOINC code 6425-4 was added. Is the code listed in Table MPM-B missing a digit?
12.16.2012 Guidelines for Relative Resource Use Measures The table under step 9 on page 350 of the HEDIS 2013 Volume 2 should be used when assigning members to a RRU risk group. This year, the final risk score is rounded to 4 decimal places. In the table, Risk Group 1 is between 0.0000 and 0.2490. Risk Group 2 is between 0.2500 and 0.4990. To which risk group should a member be assigned whose risk score is 0.2495? The score does not fall in either group.
11.16.2012 General Guidelines If a member was included in the denominator because of inaccurate claims data, may we remove the member from the measure? How do we do this?
Members who are in the denominator because of inaccurate claims data may meet the criteria for a valid data error. Valid data errors are identified only for hybrid measures during medical record review. If a member is in the denominator because of a claim with a code specified for the measure, the medical record must contain evidence that the member does not meet measure criteria; a silent chart is not evidence that the member does not have the condition being measured. If the valid data error criteria are met, the member should be removed from the sample and replaced with a member from the oversample.
Finding valid data errors is not intended to be a method of correcting improper billing practices, and they cannot be identified through supplemental data. Additional information and examples of valid data errors can be found in the Substituting Medical Records in the Guidelines for Calculations and Sampling (page 51).
This applies to the following Programs and Years:
HEDIS 201311.16.2012 Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia The CMC event/diagnosis criteria were revised in the Volume 2 Technical Update to include both facility and professional claims when identifying an AMI or CABG event. Should both facility and professional claims be included when identifying AMI or CABG for the SMC measure?
11.16.2012 Use of High-Risk Medications in the Elderly When calculating the Average Daily Dose for medications in Table DAE-C, should organizations use rounding rules before comparing the dose to the specified threshold? How should organizations calculate average daily dose for elixirs and concentrates?
11.16.2012 Medication Reconciliation Post-Discharge If a member's discharge is followed by a readmission or direct transfer to a nursing home or long term care facility, is the discharge included in the measure's denominator?
If there is evidence that the member remained in the nursing home or long-term care facility through December 1 of the measurement year, the discharge must be excluded from the denominator. If there is evidence that the member was discharged from the nursing home or long term care facility by December 1 of the measurement year, the discharge must be included in the denominator. Organizations may not assume that the member remained in a nursing home or long-term care facility through the end of the measurement year, based solely on the discharge status; there must be a method for identifying the members status for the remainder of the measurement year.
This applies to the following Programs and Years:
HEDIS 201311.16.2012 Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia In the Volume 2 Technical Update, the Continuous Enrollment criteria were revised to read "the measurement year and the year prior to the measurement year." Should the Allowable Gap criteria also include the year prior to the measurement year?
11.16.2012 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents For the Counseling for Nutrition and Counseling for Physical Activity indicators, do educational materials sent to members via mail or e-mail count toward the numerators?
No. The intent of the measure is to identify instances where a member received counseling for nutrition and physical activity; therefore, educational materials sent via mail or e-mail do not indicate that counseling occurred. The intent of including "member received educational materials" in the measure specifications is to allow for occasions where a provider gave educational materials to a patient during a face-to-face visit.
This applies to the following Programs and Years:
HEDIS 201311.16.2012 Care for Older Adults May a yes/no checklist be used for the advance care planning indicator?
If "yes" is checked, it may be counted as evidence that the member executed an advance care plan. If "no" is checked, evidence of an advance care planning discussion must be documented. A checklist does not count as evidence of a discussion.