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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9.15.2010 ABMS or AOA board performance-based improvement module Are physicians required to update their performance improvement module (PIM) data every two years, or must the organization check every two years to find out who has completed a PIM?

The organization must verify that a physician has completed a PIM within two years of the organization taking an action, or within the period specified for the corrective action process, which must be within a two-year period to qualify as a quality measurement activity.

This applies to the following Programs and Years:

8.13.2010 Acceptable threshold for percentage of physicians in a practice necessary to designate a practice If our organization designates at the practice level, is an individual measure (e.g. meeting an e-prescribing measure or practicing in a designated center of excellence) acceptable for designating the group based on a percentage of physicians in the group who meet the measure?

Yes, with a caveat: your organizations methodology must specify a threshold for the percentage of physicians meeting the measure, which must not be less than 50%. If the percentage of physicians meets or exceeds this threshold, then your organization may use an individual measure to designate the practice.

This applies to the following Programs and Years:

7.16.2010 General Guidelines Does upgrading to Accredited With Performance Reporting status extend the accreditation expiration date?

Yes. The Accredited With Performance Reporting status is valid for up to three years from the date of the final results of the Initial Survey, subject to revision from annual WHP Performance Measures results submission.

This applies to the following Programs and Years:

7.15.2010 Notification of information available on the Web site Which methods are acceptable for notifying members or practitioners in writing that information is available on the Web site?

Organizations may use mail, fax or e-mail to notify members or practitioners that information is available on the Web site.

This applies to the following Programs and Years:

3.29.2010 Automatic credit for file review Does the 70 percent criterion for automatic credit apply to file-review elements when using an NCQA Accredited or NCQA Certified delegate?

No. The 70 percent criterion for automatic credit does not apply to CR or UM file review elements in which the delegate is NCQA Accredited or NCQA Certified in CR or UM. All CR or UM files from NCQA Accredited or Certified delegates are eligible for automatic credit regardless of the percentage of the organizations membership covered by the delegates services.

This applies to the following Programs and Years:

1.22.2010 Quality measures Does Board Certification status count as a quality measure?

No, Board Certification status alone does not count as a quality measure.

This applies to the following Programs and Years:

4.15.2009 Removal of Must-Pass from PHQ 1 Element A Is PHQ 1, Element A no longer a must-pass element? If so, is the change permanent?

PHQ 1, Element A is no longer a must-pass element; this is a permanent change. The designation has been removed in ISS. If in the future, NCQA recommends must-pass status for this element, it will go out for Public Comment and Board approval before it is changed.

This applies to the following Programs and Years:

3.15.2009 Use of HEDIS measures in PQ certification May organizations use NQF-endorsed health plan HEDIS specifications for physician-level measurement?

Yes. Organizations may use NQF-endorsed health plan HEDIS specifications until July 1, 2010. For programs updated with new results after July 1, 2010, organizations must follow the NQF-endorsed HEDIS Physician Measurement specifications. These are generally the same as the HEDIS Health Plan specifications, but may have some modifications. If a measure in the desired area has not been endorsed by NQF, the organization may use an alternate measure from the HEDIS set and still qualify as a standardized measure, as discussed in the explanation in PHQ 1, Element A.

This applies to the following Programs and Years:

3.15.2009 Use of patient experience data collected from external organizations Is the use of patient experience data within the scope of NCQA review in the following circumstances:

1. The organization incorporates third-party performance information data with its own and then takes action on it (i.e., integrates the third-party data with its own to develop a composite that it reports or uses as the basis of action, such as payment or network or benefit design)

2. The organization provides a link for members on a third-party site so the member can review that information?

For scenario 1, the data is within the scope of review for PHQ because the organization has incorporated the data with its own or tailored the data and then used the data as a basis for its own action (e.g., reporting, payment or network or benefit design).

For scenario 2, if the organization simply provides a link to an external source of performance information on physicians without altering that data and represents it as such, and the organization does not take any action based on the data (e.g., pay any incentive or use data for network or benefit design) then it is outside the scope of review for PHQ.

This applies to the following Programs and Years:

2.15.2009 Working with Physicians What actions must an organization take to meet Element F factor 1?

The organization must provide, at the time of initial contracting, new physicians with specific performance measurements applicable to them. The organization may provide the information:

In writing

In person at meetings

On the Web, if it notifies physicians, practices or medical groups that the information is available

This applies to the following Programs and Years:

1.15.2009 Using quality and cost, resource use or utilization measures together If an organization uses quality measures for a particular specialty, may it measure episode cost for any condition treated by that specialty, or is it limited to measuring cost only for conditions where quality has been measured?

Organizations are not limited to measuring cost only for conditions where quality has been measured. An organization that measures quality for a physician specialty may measure and take action on cost, resource use and utilization for the specialty.

This applies to the following Programs and Years:

1.15.2009 Use of HEDIS measures in PQ certification May organizations use NQF-endorsed health plan HEDIS specifications for physician-level measurement?

Organizations are expected to follow the NQF-endorsed HEDIS Physician Measurement specifications. These are generally the same as the HEDIS Health Plan specifications, but may have some modifications. If a measure in the desired area has not been endorsed by NQF, the organization may use an alternate measure from the HEDIS set and still qualify as a standardized measure, as discussed in the explanation in PHQ 1 Element A.

This applies to the following Programs and Years: