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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3.16.2012 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:

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 Encounter Rate Threshold for Clinical Measures Table ENR-F Option A states to use the CMS ASC Approved HCPCS Codes and Payment Rates file and to only use the spreadsheet titled, "Addendum AA_ASC Covered Surgical Procedures (ASC_AddAA.csv) for October 2011". This exact file name is not found in the zip file on the CMS website. Please confirm the file and tab that should be used.

The file name has been updated on the CMS website. To reflect this change, the note under Table ENR-F should read as follow: * These codes can be found on the CMS Web site (http://www.cms.hhs.gov/ASCPayment/11_Addenda_Updates.asp#TopOfPage/). Click October 2011 ASC Approved HCPCS codes and Payment Rates. Use only the spreadsheet titled, Oct11_ASC_Add_AA-BB-DD1_ExtAct.xlsx, and the tab titled Oct11_ASC_AddAA-ExtAct. Only use 5-digit all-numeric CPT codes (Level 1 HCPCS) in the spreadsheet; do not include any codes with an alpha value. This update will be reflected in the September 2012 release of the MY 2012 manual.

This applies to the following Programs and Years:

3.16.2012 Continuous Enrollment and Allowable Gaps Over Multiple Years In the MY2011 P4P Manual, are the dates correct in the example for Continuous Enrollment and Allowable Gaps Over Multiple Years? They do not seem to match up to the description of gaps in enrollment.

There is an error in the manual. The first date in the example should be November 30, 2010. The full example should read as follows:

For example, in the MY 2011 Breast Cancer Screening measure (which requires 2 years of continuous enrollment), a member who disenrolls on November 30, 2010 (the year prior to the measurement year), and re-enrolls on February 1, 2011 (the measurement year), is considered continuously enrolled as long as there were no other gaps in enrollment during either year. The member has one gap of 31 days (December 1_31) in 2010 and one gap of 31 days (January 1_31) in 2011.

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

This applies to the following Programs and Years:

3.15.2012 Demonstrating improvement Must an organization achieve significant improvement on identified opportunities to meet this element?

No. Data collection methodology must be sound enough to produce valid and reliable results but achievement of significant improvement is not required for QI 10 Element A.

This applies to the following Programs and Years:

3.15.2012 Analysis of complaint and appeal data May organizations analyze complaint data by the five specified complaint categories and analyze appeal data by the type of procedures appealed?

No. While the organization may have different complaints and appeal category for business purposes, it must analyze and report both complaint and appeal data by the five specified categories for NCQA purposes. Even if the organization has no complaints or appeals in one or more reporting categories, it must still demonstrate its analysis and report the number of complaints and appeals for all five categories.

This applies to the following Programs and Years:

3.15.2012 Cultural preference If an organization only assesses language and gender and matches member and practitioner based on linguistic and gender data, is this acceptable for QI 4, Element A, factor 1?

No. Organizations must assess members cultural, racial, ethnic and linguistic needs then take actions based on its findings. Leaving out one or more of the required assessment areas would not meet the intent of the element.

This applies to the following Programs and Years:

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?

Yes. If performance issues are identified through organization-wide analysis, the organization must perform an analysis at the practitioner level to identify the cause. Practitioner-level assessment may include the total population or a statistically valid sample.

This applies to the following Programs and Years:

3.15.2012 QI Work Plan Must the QI work plan address all the items listed under Work plan in the explanation to receive credit for QI 1, Element A, factor 9?

Yes. To receive credit for factor 9, the work plan must address all ten items listed Work Plan in the explanation.

This applies to the following Programs and Years:

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?

No. More than one practitioner must be involved in QI program activities. Participating practitioners must represent a broad spectrum of specialties, as appropriate.

This applies to the following Programs and Years:

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?

For MY 2011 P4P tables CWP-C and URI-D, crosswalk to the HEDIS 2012 NDC list for table CWP-C.

*Note: The MY 2011 P4P crosswalk to HEDIS 2012 NDC List posted on December 8, 2011, has been corrected.

This applies to the following Programs and Years:

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?

No. For the MUHIT domain, functionality means a fully operational and implemented system that has been in use since October 1, 2011. An organization that has an EHR in place, but is not using it as defined in the measure intent statement, does not receive any points for that measure.