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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4.16.2012 Meaningful Use of Health Information Technology (MUHIT) In the November 2011 release of the MY2011 P4P Manual, the examples for scoring of the MUHIT domain in the Description and Domain Structure sections (pp 114 and 115) seem to have incorrect calculations. Is this an error?

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.

This applies to the following Programs and Years:

4.16.2012 Use of Imaging Studies for Low Back Pain (LBP) In the November 2011 release of the MY2011 P4P Manual, the table LBP-D contains an invalid CPT code, 72011. Is this an error?

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.

This applies to the following Programs and Years:

4.16.2012 Proportion of Days Covered by Medications (PDC) The Eligible Population criteria state that continuous enrollment for PDC is the index prescription date (IPD) through the end of the measurement year or until death or disenrollment, and that there is no allowable gap. Are members with two separate enrollment periods that meet the 90 day requirement excluded because of the gap in enrollment, or are they counted as two separate measurement periods?

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.

This applies to the following Programs and Years:

3.16.2012 Avoidance of Antibiotic Treatment for Adults With Acute Bronchitis (AAB) In the November 2011 release of the MY 2011 P4P specifications, Table AAB-E: Antibiotic Medications does not match exactly with Table AAB-D in the 2012 HEDIS volume. Is this an error?

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.

This applies to the following Programs and Years:

3.16.2012 Appropriate Testing for Children With Pharyngitis (CWP) In the November 2011 release of the MY 2011 P4P specifications, Table CWP-C: Antibiotic Medications does not match exactly with Table CWP-C in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In Table CWP-C: Antibiotic Medications,

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

in the row Macrolides the drug Erythromycin estolate should not be in the table,

in the row Third generation cephalosporins, the drug Cefditoren should be included in the table.

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

This applies to the following Programs and Years:

3.16.2012 Breast Cancer Screening (BCS) On the Clinical Measure file layout the BCS measure is listed as Breast Cancer Screening: Ages 52-69 but the measure description indicates that it is for ages 50 _ 69. Is there an error in the Clinical Measure file layout?

The Clinical Measure file layout is correct. The age band is described as starting at age 52 to account for the two year look-back period for this measure.

This applies to the following Programs and Years:

3.16.2012 Diabetes Care Blood Pressure Control (<140/90 mm Hg) In the November 2011 release of the MY 2011 P4P specifications, Blood Pressure Control (<140/90 mm Hg) for Diabetes replaced exclusions with the note, The blood pressure reading must be in conjunction with an outpatient visit code or a nonacute inpatient visit code from Table CDC-C. This new note requires physician organizations to map blood pressure pulled from a registry to claim data to identify the specific visit codes. This change is extremely burdensome! Why was it necessary?

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.

This applies to the following Programs and Years:

3.16.2012 Asthma Medication Ratio (AMR) In the November 2011 release of the MY 2011 P4P specifications, Table AMR-C: Asthma Medications does not match exactly with Table ASM-C in the 2012 HEDIS volume. Is this an error?

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.

This applies to the following Programs and Years:

3.16.2012 Proportion of Days Covered by Medications (PDC) In the November 2011 release of the MY2011 P4P specifications, the wording under Definitions and Eligible Population is confusing. The definition of the Index Prescription Date (IPD) states that the index date should occur at least 91 days before the end of the measurement period, but under Continuous Enrollment, the manual states that the IPD must occur at least 91 days prior to the end of the measurement year. Should we be looking back from the end of the measurement period or the end of the measurement year?

The Index Prescription Date (IPD) should occur at least 91 days before the end of the measurement period, as stated in the definition of IPD. The Continuous Enrollment section should refer to the measurement period, for both self-reporting POs and for health plans.

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

This applies to the following Programs and Years:

3.16.2012 Appropriate Treatment for Children with Upper Respiratory Infection (URI) In the November 2011 release of the MY 2011 P4P specifications, Table URI-D: Antibiotic Medications does not match exactly with Table CWP-C in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In Table URI-D: Antibiotic Medications, in the row First generation cephalosporins, the drug Cephradine should not be in the table, in the row Macrolides the drug Erythromycin estolate should not be in the table, in the row Third generation cephalosporins, the drug Cefditoren should be included in the table. These errors will be corrected in the September 2012 release of the MY 2012 manual.

This applies to the following Programs and Years:

3.16.2012 Diabetes Care (CDC) In the November 2011 release of the MY 2011 P4P specifications, Table CDC-A: Prescriptions to Identify Members With Diabetes does not match exactly with Table CDC-A in the 2012 HEDIS volume. Is this an error?

There is an error in the manual. In Table CDC-A: Prescriptions to Identify Members With Diabetes, in the row Miscellaneous antidiabetic agents, the drug Liraglutide should be included in the table.

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

This applies to the following Programs and Years:

3.16.2012 Annual Monitoring for Patients on Persistent Medications (MPM) In the November 2011 release of the MY 2011 P4P specifications, Table MPM-A: Drugs to Identify Members on ACE Inhibitors or ARBs does not match exactly with Table CDC-L in the 2012 HEDIS volume. Is this an error?

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.

This applies to the following Programs and Years: