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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1.17.2012 Use of Virtual Hold in call abandonment rates Our member phone system measures wait time. If the wait time hits a certain threshold, members can hang up, keep their place in the queue and receive an automatic call back when the next customer support person is available. The system is set to call back every five minutes, for three attempts. When members answer the call-back, they are connected to the customer support person. If a member does not answer after three attempts, is the call considered abandoned, based on the Call Abandonment criteria?

Yes. If the member does not answer the call-back, it is counted as abandoned. If the member answers the call-back and the reports show the results, the call is not counted as abandoned because the member was kept in the queue.

For timeliness (Element C, factor 1), because it is unlikely that the system would start the call-back process before 30 seconds, the call counts as answered outside the 30 seconds.

1.17.2012 Use of Virtual Hold in call abandonment rates Our member phone system measures wait time. If the wait time hits a certain threshold, members can hang up, keep their place in the queue and receive an automatic call back when the next customer support person is available. The system is set to call back every five minutes, for three attempts. When members answer the call-back, they are connected to the customer support person. If a member does not answer after three attempts, is the call considered abandoned, based on the Call Abandonment criteria?

For timeliness (Element C, factor 1), because it is unlikely that the system would start the call-back process before 30 seconds, the call counts as answered outside the 30 seconds.

1.17.2012 Use of Virtual Hold in call abandonment rates Our member phone system measures wait time. If the wait time hits a certain threshold, members can hang up, keep their place in the queue and receive an automatic call back when the next customer support person is available. The system is set to call back every five minutes, for three attempts. When members answer the call-back, they are connected to the customer support person. If a member does not answer after three attempts, is the call considered abandoned, based on the Call Abandonment criteria?

For timeliness (Element C, factor 1), because it is unlikely that the system would start the call-back process before 30 seconds, the call counts as answered outside the 30 seconds.

1.16.2012 Meaningful Use of Heath IT Will PCPs who use certified modules and do some meaningful use measures get credit for the measures?

Yes, although because MUHIT is scored at the measure level, PCPs might receive credit for some measures and not for others.

1.16.2012 Proportion of Days Covered by Medications The definition for index prescription date states that the index date should occur at least 91 days before the end of the measurement period. The measurement period is defined as the index date through the last day of the measurement year or until death or disenrollment. How should an organization handle a situation where a members first fill date is January 1, 2011, and the member disenrolls from the plan on March 15, 2011? How should an organization handle a situation where a members first fill date is November 1, 2011? Should the member be excluded from the measure?

In the first scenario, the index date is 74 days prior to the end of the measurement period, so the member should be excluded. In the second scenario, the index date is 61 days prior to the end of the measurement period, so the member should be excluded.

1.16.2012 PR 1: Internet Portal for Notification of Patient Engagement May organizations notify practitioners via an Internet portal for PR 1, Element A, factor 8?

Yes, if the organization's documented process includes how it notifies practitioners that the information is available on the Internet; and if the organization informs practitioners where the information is located. If all practitioners do not have access to the portal, the organizations process must include how it notifies these practitioners of patient engagement.

1.16.2012 Proportion of Days Covered by Medications For all rates, step 2 of the numerator states that organizations should count the days when a member was covered by at least one drug in the class. However, each rate indicates that there are additional eligible population criteria for the member to have filled at least two prescriptions for the target drug. How can the numerator allow for just one drug in the class to be filled?

At least two prescriptions means that the patient had at least two pharmacy claims for a drug in the target class (this can be refills for the same drug). In the numerator, for a day to be covered, a patient must have a supply on hand of at least one drug in the class.

1.16.2012 Proportion of Days Covered by Medications How do you account for claim reversals?

PDC measures are calculated through use of paid, nonreversed claims for target medications. If the drug claims dataset contains claim reversals (and paid claims that were reversed), analysts must ensure that the reversed claims are not used to calculate PDC. Claim reversals can be identified through multiple methods because there may be multiple fields in a drug claim that indicate whether it is a reversal. Many drug claims datasets have a Count field that contains a 1 for a paid claim and a -1 for a claim reversal. The dataset may also have a field called Reversal that contains a Y if the claim is a reversal claim, or an N if it is not a reversal. Reversal claims typically have a negative quantity and a negative cost.

The claim reversal (-1 in the Count field or Y in the Reversal field) may have a Claim Number that is identical to the original claim being reversed. If the Claim Number for the reversal claim is not identical to the Claim Number for the original claim, analysts can create coding logic that will identify the reversed claim as immediately preceding the claim reversal. This latter approach is not usually necessary because most drug claims datasets allow a claim reversal to be linked to an original claim.

1.16.2012 Evidence-Based Cervical Cancer Screening of Average-Risk, Asymptomatic Women A new exclusion code (ICD 279) was added to the Evidence-Based Cervical Cancer Screening of Average-Risk, Asymptomatic Women measure, but no guidance was provided on time frame to allow the exclusion.

For this exclusion, look back as far as possible in the members history.

1.16.2012 Proportion of Days Covered by Medications How should organizations count days when a member is covered by a drug in step 2 of the numerator for each rate? The specification states that if prescriptions for the same drug overlap, the prescription start date should be adjusted to be the day after the previous fill has ended. Does this mean that if a member fills a prescription for a 30-day supply of a drug on January 1, 2011, and fills another prescription for the same drug on January 15, 2011, also with a 30-day supply, the days covered is 45 days (30 days for the prescription filled on January 1; 15 days for the drug filled on January 15)?

Sixty days are covered. The first prescription lasts 30 days, starting January 1. If you move the next prescription's start date to the day after the previous fill has ended, it becomes January 31. The end date is March 1. In essence, the start date and the end date of the second prescription both move.

1.16.2012 Proportion of Days Covered by Medications Should days covered be capped at the number of days for the measurement period? For example, if a members measurement period is January 1_June 30, 2011 (180 days), and the member fills different prescriptions within the class (different GCNs) on January 1, April 1 and June 15, all with a 90-day supply (195 days within the measurement period), should the days covered be calculated as 180 days?

In your example, the measurement period is 180 days (January 1_June 30). Step 2 of the numerator criteria reads, "within the measurement period, count the number of days the member was covered." In this case, look for covered days from January 1_June 30; in essence, the numerator is being capped. The PDC is not calculated by summing the days supply for pharmacy claims. You may need to set up a time array for each claim, to identify the time frame covered by each fill, then count the number of days in the measurement period that are covered by the time arrays. Thus, the numerator may not exceed the denominator for the person-level PDC calculation. Refer to the attached example for SAS code for arrays.

12.16.2011 Health Appraisal Completion The incentive criteria was revised in 2012. If an incentive is tied to completion of an HA as well as another activity, what category should the incentive be reported under?

If an incentive is tied to completion of an HA as well as another activity, the incentive should be classified as Unknown for WHP 2012 reporting. Please note that example 4 in Table HAC-A was erroneously left in the specification for 2012; this example should be removed from the table.