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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NCQA does not prescribe the cost measures an organization selects, though it requires an organization to specify all aspects of its methodology (Element C). In addition, the organization must risk-adjust its measures (Element C, factor 8) and must meet the minimum statistical requirements for measurement error and measure reliability (PQ1 Element D, factor 2).
Yes. QI 9, Element D is NA for Renewal Surveys for all factors. This is because organizations that undergo Renewal Surveys are already required to submit and are scored on preventive health HEDIS measures. Organizations undergoing Interim and First Survey options are not required to submit HEDIS measures.
Yes. In prior versions of PHQ, NCQA required organizations to include all programs that met the definition of taking action in the survey, NCQA had a narrower definition. Because under PHQ 2013 organization chooses which programs to include or exclude in a PHQ survey, NCQA has broadened the definition so that if it chooses, an organization may opt to have programs certified that may not have been required under the prior PHQ.
For PHQ 2013, NCQA has defined taking action as: 1) Publicly reporting performance on quality or cost, resource use or utilization; 2) Using performance on quality or cost, resource-use or utilization measures as a basis for network design (such as tiering) or benefit design; 3) Using performance on quality or cost, resource-use or utilization measures to allocate rewards under a systematic, pay-for-performance program; 4) Reporting performance on quality, cost, resource use or utilization to physicians to support referral decisions.
If an organization is interested in certification for a program that includes actions not include an action defined above, it should contact NCQA to determine eligibility.
NCQA does not specify a minimum period after a denial during which an organization may undergo a new review, but the organization must have completed a new cycle of measurement and action in order for NCQA to review it against the standards.
No. An organization is required to purchase a separate survey tool for every program it brings forward. One program operated by an organization such as a corporate parent without variation from region to region may be surveyed using a single tool. An organization that brings forward more than one program must purchase and submit a separate tool for each discrete program it brings forward.
There is a pricing option for derivative programs a derivative program is defined as a program that shares common aspects (e.g. an organization uses the same measures and methodology for a single defined group of physicians but takes a different action (reporting vs. network tiering) as another program its organization brings forward for certification. NCQA can review common aspects once to streamline the survey process (thus the discounted price), although these are distinct programs. To receive a discount, the programs must be brought forward at the same time. Please see the pricing exhibit in the survey agreement. If you need additional information, please contact NCQA Customer Support at (888) 275-7585.
Board certification alone does not count as a quality measure. The organization may take action based on physician completion of an ABMS or AOA board performance-based improvement module (generally, in conjunction with maintenance of certification) at least every two years. These activities may be used as a quality measurement activity to meet PQ 1 Element A. Under certain circumstances, the organization may use measures from other national or regional performance-based designation programs to satisfy some or all requirements for PQ 1, Element A. The organization must discuss this in advance with NCQA to determine if the designation program meets the criteria.
For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution, statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.
For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution, statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.
Yes. Patient experience measures are considered measures of quality. The organization may use items or composites from the CAHPS-CG survey. Measure specifications for the CAHPS-CG survey can be found on the AHRQ website (https://cahps.ahrq.gov/clinician_group/).
For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution,statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.
No. Changing the referent time period materially alters the measure and would therefore not qualify as a standardized measure for Element A. Patient experience measures endorsed, developed or accepted by the NQF, AMA PCPI, national accreditors or government agencies may be used, but the organization must follow the measure or instrument specifications as written.
