If information is available to the public–even if it is only available by request–NCQA considers this to be public reporting. Therefore, in this scenario the taking action date is December 1.
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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11.15.2012 Working with Physicians Our organization posts the results of our physician measurement program on our directory on January 1 and any tiered networks or differential benefits are effective that same date. We make the results available to members by request (e.g. the member can call an 800 number to ask about a physicians status in the tiered network) on December 1. Which date _ January 1 or December 1 _ does NCQA consider the action date for the purposes of calculating whether we notify physicians 45 days ahead of action and resolve requests for corrections or changes before taking action?
11.15.2012 NA scoring for Renewal Surveys in QI 9 The 2013 edition of HP states that for QI 9, Element D, Performance Measurement, the look-back period for Renewal Surveys is NA. Is this correct?
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.
This applies to the following Programs and Years:
11.15.2012 Defining "Taking Action" Is there a new definition of taking action in the 2013 PHQ Standards?
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.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Definition of a Program How does NCQA define a 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.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Board Certification Does Board Certification status count as a quality measure?
11.15.2012 Reapplying for certification When may an organization that fails to be certified reapply?
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.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Physician requests For PQ 2 Element C, could a collaborative manage the process?
Yes. PHQ requirements do not prohibit a collaborative from managing a request for corrections or changes made by physicians, but the organization remains accountable and responsible for responding to complaints from consumers and to requests for changes from physicians or hospitals based on actions taken by the organization.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Tools for readiness evaluations Is there a non-Web based tool available for our organization to use for self-assessment?
An organization can use the PDF version of the standards to assess readiness to undergo a survey, but in order to undergo a survey it must purchase and use the Web-based Interactive Survey System (ISS) Tool. To purchase the PDF version of the standards or the Survey Tool, visit the NCQA Web site (www.ncqa.org) or contact Customer Service at 888-275-7585.
This applies to the following Programs and Years:
PHQ 201311.15.2012 TDD/TYY requirements May organizations use State Relay services in lieu of offering TDD/TTY services?
11.15.2012 Collaborative data Must organizations include collaborative data for certification?
11.15.2012 Pricing for Derivative Programs How does NCQA determine which pricing tier it places a derivative product in?
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.
This applies to the following Programs and Years:
PHQ 201311.15.2012 Requests for corrections or changes For PQ2: Elements B and C, how can patient experience of care data corrected, when this information is not disclosed to physicians?
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.
