FAQ Directory

No. With the exception of ABMS or AOA sponsored boards, NCQA requires organizations to determine and list specialty boards they accept within their credentialing policies and procedures. At a minimum, at least annually, organizations must obtain written confirmation from the specialty board that it performs primary-source verification of education and training. A specialty board that provides annual written confirmation that it conducts primary source verification of education and training can be used as an acceptable source for verification of education and training if the organization names the specialty board in its policies and procedures.

The organization must verify board certification status for any practitioner claiming to be certified by an ABMS or AOA sponsored boards, or by a specialty board recognized by the organization.

No. With the exception of ABMS or AOA sponsored boards, NCQA requires organizations to determine and list specialty boards they accept within their credentialing policies and procedures. At a minimum, at least annually, organizations must obtain written confirmation from the specialty board that it performs primary-source verification of education and training. A specialty board that provides annual written confirmation that it conducts primary source verification of education and training can be used as an acceptable source for verification of education and training if the organization names the specialty board in its policies and procedures.

Yes. E-mailed correspondence suffices as written acknowledgment if it adequately outlines the delegated responsibilities of the certified organization.

Because there are no allowable gaps in this measure, exclude members who were not continuously enrolled, including members who had more than one 90+ day measurement period.

Yes. The first CPT code in the table should be 72010. This error will be corrected in the September 2012 release of the MY 2012 manual.

Yes. The example on page 114 should read as follows:

100 out of 100 PCPs meet the criteria = 100%

_ 5 points for certified and 3.75 for non-certified

25 of 100 certified = ((25% * 5) = 1.25)

75 of 100 non-certified = ((75% * 3.75) = 2.81)

Total points = ((1.25+ 2.81) = 4.06)

The example on page 115, in the Point allocation for POs using ONC-ATCB certified software section, should read as follows:

For example, if a PO earned 60 points, its overall calculated P4P score would be 18. Scores are rounded to the nearest whole number.

These errors will be corrected in the September 2012 release of the MY 2012 manual.

P4P made this change to align with HEDIS, but did not consider the unintended impact it will have on POs, which must pull the information from EHRs. Because of the burden to POs, P4P will revert to the prior language for this measure, outlined below.

When identifying the most recent BP reading noted during the measurement year, do not include BP readings that meet the following criteria.

BPs taken during an acute inpatient stay (Table CDC-O)

BPs taken during an ED visit (Table CDC-P)

BPs taken during an outpatient visit where a diagnostic test or surgical procedure was performed (e.g., sigmoidoscopy, removal of a mole) or BPs obtained the same day as a major diagnostic or surgical procedure (e.g., stress test, administration of IV contrast for a radiology procedure, endoscopy) (Table CDC-Q)

BP readings taken by the member.

There is an error in the manual. In the Table MPM-A: Drugs to Identify Members on ACE Inhibitors or ARBs, in the row Antihypertensive combinations the drugs Aliskiren-valsartan, Amlodipine-hydrochlorothiazide-valsartan, Amlodipine-hydrochlorothiazide-olmesartan and Amlodipine-telmisartan should be included in the table.

This error will be corrected in the September 2012 release of the MY 2012 manual.

The file name has been updated on the CMS website. To reflect this change, the note under Table ENR-F should read as follow: * These codes can be found on the CMS Web site (http://www.cms.hhs.gov/ASCPayment/11_Addenda_Updates.asp#TopOfPage/). Click October 2011 ASC Approved HCPCS codes and Payment Rates. Use only the spreadsheet titled, Oct11_ASC_Add_AA-BB-DD1_ExtAct.xlsx, and the tab titled Oct11_ASC_AddAA-ExtAct. Only use 5-digit all-numeric CPT codes (Level 1 HCPCS) in the spreadsheet; do not include any codes with an alpha value. This update will be reflected in the September 2012 release of the MY 2012 manual.

There is an error in the manual. In Table CHL-A: Prescriptions to Identify Contraceptives,

in the row Contraceptives, the drugs Estradiol-medroxyprogesterone, Levonorgestrel, Medroxyprogesterone, and Norethindrone should be included in the table,

the drug Levonorgestrel-medroxyprogesterone should not be in the table.

These errors will be corrected in the September 2012 release of the MY 2012 manual.

There is an error in the manual. In the Table AMR-C: Asthma Medications, in the row Inhaled steroid combinations the drug Bluticasone-salmeterol should read Fluticasone-salmeterol.

This error will be corrected in the September 2012 release of the MY 2012 manual.

There is an error in the manual. In Table AAB-E: Antibiotic Medications,

the first two rows, 5-aminosalicylates and Amebicides should not be in the table,

in the row Aminoglycosides the drug Neomycin should not be in the table,

in the row First generation cephalosporins, the drug Cephradine should not be in the table,

in the row Miscellaneous antibiotics the drug Vancomycin should be included in the table,

the row sulfamethoxazole-trimethoprim DS should not be in the table,

in the row natural penicillins the drug Penicillin G benzathine should be included in the table,

in the row Third generation cephalosporins, the drugs Cefditoren and Cefpodoxime should be included in the table,

in the row Third generation cephalosporins, the drug Cefoperazone should not be in the table.

These errors will be corrected in the September 2012 release of the MY 2012 manual.