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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5.16.2011 General Guidelines If a DM organization does not meet the 15,000 minimum enrollment threshold, may it submit DM measure results to NCQA to be scored as a part of accreditation?

Yes. NCQA is lowering the enrollment threshold for DM 2012 and allowing optional reporting for organizations that do not meet this requirement. Because the threshold will change next year, DM organizations that do not meet the threshold may report in 2011 and earn the Accredited With Performance Reporting status.

4.16.2011 Quality assessments for Organizational Providers Must organizations conduct an onsite quality assessment of non-accredited providers?

No. Organizations must conduct a quality assessment of nonaccredited providers, but the quality assessment does not need to occur onsite for MA Deeming Surveys.

4.16.2011 Measure Specifications NCQA requires that an organizations measure specifications exactly match the specification of the standardized measure in order to receive credit for PHQ 1 A. In some cases, National Quality Forum (NQF)) or Ambulatory Quality Alliance (AQA) may have endorsed or accepted a measure specification which has subsequently been updated by the measure developer based on changes to underlying clinical evidence, coding, etc. If NQF or AQA have not yet updated the endorsement/acceptance, does the organization still receive credit if it is using the most recent specification from the measure developer?

Yes. An organization that uses the most current specifications from the measure developer meets the intent of PHQ 1, Element A for that measure, even if the NQF or AQA acceptance/endorsement has not been updated.

1.17.2011 Prenatal and Postpartum Care The LOINC codes listed for rubella for Decision Rule 3 in Table PPC-C are inconsistent with the LOINC codes listed for rubella in other sections of Table PPC-C. Is this accurate?

No. LOINC codes listed in the Rubella/ABO/Rh category for Decision Rule 3 should match the LOINC codes listed in other categories (e.g., the LOINC codes listed for the Rubella/ABO/Rh category in Decision Rule 2).

1.17.2011 Comprehensive Ischemic Vascular Disease Care CPT Category II code 3076F became obsolete January 1, 2007. Should it be deleted from Table IVD-G?

Yes. Delete the code from Table IVD-G.

1.17.2011 Comprehensive Ischemic Vascular Disease Care Should CPT Category II codes 3074F and 3075F be included in Table IVD-G?

Yes. 3074F (systolic less than 130 mm Hg) and 3075F (systolic 130_139 mm Hg) were inadvertently removed from Table IVD-G, but they should be included because they define BP systolic levels of less than 140 mm Hg.

11.15.2010 Use of the term "days" within the Standards & Guidelines Do all references to "days" in the standards and guidelines mean "calendar days"?

Yes. Unless otherwise specified, all references to "days" in the standards and guidelines mean calendar days.

PHQ 2013

9.16.2010 Comprehensive Diabetes Care Considering the release of several new relevant studies, is NCQA changing the threshold of the BP control <130/80 mm Hg indicator?

Yes. In light of recent studies, and after discussion with the Joint Diabetes Expert Panel, NCQA decided to change the BP control “<130/80 mm Hg” indicator to BP control <140/80 mm Hg. This change will be in the Volume 2 Technical Update that will be released October 1, 2010.

9.16.2010 General Guidelines What is the annual release date of the DM Technical Specifications, and when are the data due to NCQA?

The DM Technical Specifications are released annually on July 31. Data are due by June 30.

9.16.2010 General Guidelines What is the annual release date of the WHP Technical Specifications, and when are the data due to NCQA?

The WHP Technical Specifications are released annually on March 30. Data are due by April 15.

9.15.2010 ABMS or AOA board performance-based improvement module Are physicians required to update their performance improvement module (PIM) data every two years, or must the organization check every two years to find out who has completed a PIM?

The organization must verify that a physician has completed a PIM within two years of the organization taking an action, or within the period specified for the corrective action process, which must be within a two-year period to qualify as a quality measurement activity.

8.13.2010 Acceptable threshold for percentage of physicians in a practice necessary to designate a practice If our organization designates at the practice level, is an individual measure (e.g. meeting an e-prescribing measure or practicing in a designated center of excellence) acceptable for designating the group based on a percentage of physicians in the group who meet the measure?

Yes, with a caveat: your organizations methodology must specify a threshold for the percentage of physicians meeting the measure, which must not be less than 50%. If the percentage of physicians meets or exceeds this threshold, then your organization may use an individual measure to designate the practice.