No. More than one practitioner must be involved in QI program activities. Participating practitioners must represent a broad spectrum of specialties, as appropriate.
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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3.15.2012 Practitioner participation in the QI program QI 2, Element A, factor 3 requires practitioner participation in the QI program. Is it enough for an organization to only include a medical director in planning, design, implementation and review of the QI program?
3.15.2012 Assessment against access standards If the organization-level assessment shows that established goals and thresholds were not met for access to appointments, must there be an additional assessment at the practitioner level?
2.16.2012 MY 2011 P4P Crosswalk to HEDIS 2012 NDC List When looking for the NDC list for P4P tables CWP-C and URI-D, to which table in HEDIS should we crosswalk?
2.16.2012 Meaningful Use of Heath IT (MUHIT) For MY 2011, what is the definition of Primary Care Providers (PCPs)? Does this include Pediatricians?
2.16.2012 Meaningful Use of Heath IT (MUHIT) Page 115 of the manual was updated to state, POs must have functional EHRs in place 90 days before the end of the measurement year (i.e., the POs EHRs must be functional by October 1, 2011). Define functionality. Our organization has been using an EHR system for a number of years (before October 1, 2011), but we have a backlog in becoming fully functional, as defined in each measure. Do we receive credit for all of the measures?
2.16.2012 Health Plan Clinical Measure File Layout Why are there three example tabs in the MY 2011 Health Plan Data Submission file layout?
In MY 2011, health plans may submit results for the Medicare product line and for the commercial product line. Because the Medicare product line is now reported by health plans, the Health Plan Clinical and Testing Measure file layouts have three tabs for the possible reporting scenarios (commercial HMO/POS and Medicare, commercial HMO/POS only, Medicare only).
Scenario 1: The health plan has both commercial HMO/POS and Medicare product lines
Clinical Measure File Layout: Plans that report for both the commercial HMO/POS and Medicare populations must have 66 clinical measure IDs per DMHC ID/Sub Unit, even if an individual PO has only commercial or Medicare enrollment.
Testing Measure File Layout: Plans that report for both the commercial HMO/POS and Medicare populations must have 31 clinical measure IDs per DMHC ID/Sub Unit, even if an individual PO has only commercial or Medicare enrollment.
Refer to Tab (5) Sample HP FileBoth Commercial and Medicare
Examples 1_3: The plan has commercial and Medicare product lines; Pos 11111-00, 22222-03, 22222-05 and 33333-05 also have commercial and Medicare members: the plan submits commercial and Medicare data for these Pos.
Example 4: The plan has commercial and Medicare product lines; PO 44444-01 has only Medicare members: the plan submits Medicare data for PO 44444-01 and populates commercial rows for PO 44444-01 with zero enrollment, zero denominator, zero numerator and rate NB.
Scenario 2: The health plan has commercial HMO/POS product line only
Refer to Tab (6) Sample HP FileCommercial Only: Plans that have the commercial product line only submit data for the commercial product. There are no rows for the Medicare product.
Clinical Measure File Layout: The plan reports 59 clinical measure IDs per DMHC ID/Sub Unit for the commercial product.
Testing Measure File Layout: The plan reports 10 testing measure IDs per DMHC ID/Sub Unit for the commercial product.
Scenario 3: The health plan has Medicare product line only
Refer to Tab (7) Sample HP FileMedicare Only: Plans that have the Medicare product line only submit data for the Medicare product. There are no rows for the commercial HMO/POS product.
Clinical Measure File Layout: The plan reports 7 clinical measure IDs per DMHC ID/Sub Unit for the Medicare product.
Testing Measure File Layout: The plan reports 21 clinical measure IDs per DMHC ID/Sub Unit for the Medicare product.
2.16.2012 Meaningful Use of Heath IT (MUHIT) Define intent as used in the Scoring and Required Submission sections of each measure. How do we know we meet a measures intent, with respect to Required Submission item 4 and Assigned Points item 5?
For the MUHIT domain, intent refers to the measures criteria, as specified in the Intent section. For Required Submission item 4, count the number of PCPs, or the number of patients assigned to PCPs who meet the criteria listed for each measure. Assign the number of points that correspond to the percentage of PCPs meeting the measures intent.
2.15.2012 Verifying Sanction Information Every 30 Calendar Days Are organizations required to verify sanction information at recredentialing if the information is verified within 180 calendar days at initial credentialing, and every 30 calendar days thereafter?
The answer depends on whether the organization presents sanction information every 30 days to its Credentialing Committee. If so, there is no need to report it at the time of recredentialing. If not, the organization would need to verify and present adverse information to the Credentialing Committee at recredentialing.
2.15.2012 Personal care add-on benefits Are personal care services that are add_on benefits, such as cooking, grooming, transporting, cleaning and assistance with other ADL activities that are not part of medical benefit, subject to review under UM 4-UM 7?
No. Add-on personal care services do not fall within the scope of UM 4-UM 7, but they can be appealed under RR 2 or UM 8 and UM 9. Personal care services that are a part of the medical benefit fall within the scope of medical necessity review if an assessment must be done to determine the member is eligible for the services or if the services will be covered. In such cases, the services would be within the scope of UM 4-UM 7.