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.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Print this page.
Print this page.
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.
An organization does not receive automatic credit for using CAHPS-CG for an NCQA Survey. For Element C, the organization must follow the aspects of the survey methodology outlined in the endorsed specification, and must specify how it will address all other aspects of methodology required by the element.
NCQA prices a program and any programs it qualifies as derivative programs using the pricing tier that includes the total number of physicians measured in all the programs an organization brings forward. No individual physician is counted more than once for the purposes of determining which pricing tier is used, but the total of all physicians in all programs determines the tier used for every program.
The definition of a program is clearly defined in Section 1 of the Policies and Procedures. A physician measurement program includes: 1) A defined group of physicians– the definition must include both physician type (e.g. specialty) and geographic area covered; 2) A defined set of clinical quality, service or patient experience measures– the program may also include a defined set of cost, resource use or utilization measures; 3) A defined methodology for producing measure results; 4) A specific action taken at a specific point in time based on the measure results.
A hospital transparency program includes: 1) A defined group of hospitals– the definition must include both hospital type and location; 2) A defined set of all-payer quality or cost measures whose results are publicly reported at a specific point in time.
Distinct programs are reviewed separately and a certification decision is issued for each. Physician measurement programs and hospital transparency programs are always distinct programs, even when operated by the same legal entity. NCQA reserves the right to determine that programs that are managed in a decentralized manner constitute distinct programs for review.
To the extent that one program is a derivative of another and share common aspects (e.g., an organization uses the same measures and methodology for a single defined physician group but takes two actions [reporting and network tiering]) and the organization seeks verification for both at the same time, NCQA can review common aspects once to streamline the survey process, although these are distinct programs.
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/).
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).
The plan is not required to disclose member-specific results, nor is it expected that a physician can correct member responses. At a minimum, the physician must be given the methodology (e.g., sampling, attribution) and survey questions and, upon request, be allowed to confirm that the patients in the universe from which the sample was drawn are his or her patients, given the methodology.
It depends on the relationship between the organization and the practitioners, and what the state licensing agency allows. If the organization contracts with the IHS and directs its members to Indian Health Clinics, there is no need to credential individual practitioners for NCQA purposes, and consequently, no need to verify practitioner licenses. The clinics would fall under CR 8 in the 2013 HP Standards and Guidelines.
However, if the organization has an independent relationship with practitioners in a clinic and directs its members to these practitioners for care, the organization must credential the practitioners. The organization must verify practitioner licenses if the state licensing agency does not recognize the IHS license as a proxy for state license. Conversely, if the state licensing agency recognizes the IHS license as a proxy for the state license, there is no need to verify practitioner licenses. The organization must provide documentation showing state acceptance of the IHS license, during its survey.
Required exclusions identify members who must be excluded from the measure, regardless of numerator compliance. They are listed as part of the eligible population criteria because members who meet the required exclusion criteria are removed when identifying the denominator of the measure. Optional exclusions should only be used to remove members that did not meet the measure's numerator criteria. Organizations may choose to apply optional exclusions, which are listed separately at the end of the measure specification, or may choose not to apply the exclusions.
