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 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 I was sent an email with log-in instructions for accessing the MUHIT survey, but I am not the contact at my organization who will be filling out the survey. Can you assign the survey to someone else in my PO?

We have assigned one contact per PO to the MUHIT survey, and that person may add as many users as necessary to the survey. Instructions for adding users to the survey are as follows:

  • Go to the Manage User tab
  • Select Add User
  • Select Create a User
  • Enter email address of the person from your PO you want to add
  • Create a password. If the contact you are adding already has access to the P4P PO reports, they will use the same password.
  • Assign one of the following two roles: Administrators: Manages users, fills out the survey, submits the survey; Assessors: Fills out the survey.

This applies to the following Programs and Years:

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 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 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:

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:

1.16.2013 Medical Record Review Validation Can an auditor substitute one member in the MRRV sample of 16 if that members chart cannot be found?

Yes, substitution for one member is acceptable only if the organization cannot collect the chart because a practitioner is unable or unwilling to release it. The auditor has two options: he can select an original sample of 17 members (16 plus 1 oversample), and use the replacement member if the organization was unable to obtain a chart for one of the first 16 members, or he can send a 17th member when he is notified that one of the original 16 charts was unobtainable.

The auditors work papers should note which members chart was refused. If possible, the auditor should get a copy of the providers refusal letter or e-mail.

This applies to the following Programs and Years:
HEDIS 2013

1.16.2013 Medical Record Review Validation For measures that are heavily or entirely reliant on MRR data (e.g., COA, ABA, WCC, CDC BPs), if an organization attempts MRR validation and fails, or is able to retrieve a only small percentage of charts, can they report an administrative rate as low as 0% (assuming no other issues are identified)?

A low administrative rate, even 0%, can be reported, if the plan wants to submit such a rate and the auditor finds no bias or other problems in the administrative process.

This applies to the following Programs and Years:
HEDIS 2013

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:

1.16.2013 Medical Record Review Validation What happens if a plan doesnt report any measures in a group?

The auditor selects one measure from each measure group that applies to the health plan, and exclusions from the exclusions group. If the plan doesnt report any measures in a particular group, the auditor will use his discretion, based on past performance and current progress, to determine if an additional measure should be selected from a group already used.

This applies to the following Programs and Years:
HEDIS 2013

1.16.2013 Medical Record Review Validation What records are included in Group F (Exclusions)?

MRRV Group F (Exclusions) includes all optional and required exclusions and valid data errors found during medical record review. It does not include records excluded through administrative data or that belong to employees or their dependents. Other hybrid medical record exclusions that should not be reviewed in Group F are exclusions for CBP and the HbA1C Less Than 7% indicator. Because of the large volume, auditors review exclusion rates for these indicators separately. See the instructions in Volume 5, page 65 for reviewing CBP and HbA1c<7%.

This applies to the following Programs and Years:
HEDIS 2013