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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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11.17.2008 Measure requirements Regarding standardized measures, will the requirement of 70% of measures being standardized increase over time or will it be held constant?
11.17.2008 Taking action on cost measures Is an organization prohibited from using cost efficiency if quality results are not available?
Yes. The organization may not take action based on cost, resource use or utilization results alone. This is a must pass requirement for certification and is consistent with the Consumer-Purchaser Disclosure Project Patient Charter.
The organization is required to consider quality in conjunction with cost, resource use or utilization when it takes action. To the extent that the organization develops and presents a composite score or rating using cost, resource use or utilization and quality measures, it must disclose the specific measures for each category and their relative weight when it determines the composite or rating.
This applies to the following Programs and Years:
11.17.2008 Exemption process for surveys Can you confirm the process for exemption for PHQ 1?
11.17.2008 Physician requests For PHQ 1 Element G, could a collaborative manage the process?
Yes. PHQ requirements do not prohibit a collaborative from managing a request for corrections or changes made by physicians, but the organization remains accountable and responsible for responding to complaints from consumers and to requests for changes from physicians or hospitals based on actions taken by the organization.
This applies to the following Programs and Years:
11.17.2008 PHQ and HP Accreditation When will the PHQ standards be folded in to the health plan accreditation standards?
11.17.2008 Standardized measures What counts in the denominator for standardized measuresall measures on which action is taken, or all quality measures on which action is taken?
11.17.2008 Surveyors for PHQ certification What organizations will conduct surveys now or in the future? Only NCQA or, for example, would Licensed HEDIS Audit Organizations conduct them?
11.17.2008 Relative Resource Use (RRU) Measures Are HEDIS RRU measures appropriate for PHQ 1 Element B?
11.17.2008 Approved measures What percentage of an organization's measures must be approved by NQF, AQA or AMA/PCPI?
To achieve certification, the organization must score at least 50% on Element A, Measuring Physician Performance. The 50% score threshold requires that at least 50% but fewer than 60% of the measures used by the organization to measure physician quality for taking action meet the element (i.e., are standardized). To achieve full points (100%), at least 70% of the measures used by the organization to measure physician quality for taking action must meet the element (i.e., must be standardized)
This applies to the following Programs and Years:
11.17.2008 Changing measure specifications With regard to patient experience measures, may we use items from CAHPS-CG but change the referent time period? For example, not rating the last 12 months, but rating the last visit and changing the response categories accordingly?
No. Changing the referent time period materially alters the measure and would therefore not qualify as a standard measure for Element A.
Patient experience measures endorsed, developed or accepted by the NQF, AQA, AMA PCPI, national accreditors or government agencies may be used, but the organization must follow the measure or instrument specifications as written.
This applies to the following Programs and Years:
11.17.2008 Requests for corrections or changes What does NCQA look for in file review with regard to requests for corrections or changes?
Element G, Request for Corrections or Changes has four factors. 1. Documentation of the substance of the request 2. Investigation of the request 3. Notification of the specific reasons for the final decision 4. Notification of the outcome prior to taking action on measure results NCQA reviews an organizations documentation to determine if it follows its process for handling physician requests for corrections or changes related to the four factors. In response to inquiries from many organizations, NCQA issued a clarification on the expectations of the process (which is scored in Element F) and the file review against that process. See the Corrections, Clarifications and Policy Changes Web page at www.ncqa.org/tabid/120/Default.aspx.
This applies to the following Programs and Years:
11.17.2008 Credit for Physician Recognition Programs Define how NCQA Physician Recognition programs can be used for autocredit.
NCQAs Recognition Program measures meet many of the elements in PHQ.
If an organization takes action based on measures in NCQAs Recognition Programs, the measures meet the elements where specified in the standards. The organization does not need to provide additional documentation about how the measures meet these elements.
NCQAs Recognition Programs are the Diabetes Physician Recognition Program (DPRP); Heart-Stroke Recognition Program (HSRP); Back Pain Recognition Program (BPRP); Physician Practice Connections (PPC); and the Physician Practice ConnectionsPatient-Centered Medical Home (PPC-PCMH).