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 HEDIS measures If we use HEDIS measures, will NCQA still look at code?

No. NCQA does not evaluate an organizations code; it reviews the organizations measure specifications and compares them to the original source specification (if applicable).

This applies to the following Programs and Years:

11.17.2008 Survey pricing How much does the PHQ Survey cost?

The cost of a PHQ Survey is based on survey and evaluation type. The current pricing table for NCQA PHQ Certification is available from the NCQA Web site at www.ncqa.org/tabid/753/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).

This applies to the following Programs and Years:

11.17.2008 Use of rental networks and hospital quality For PHQ 2, Element E, if we "rent" our national hospital network and do not contract directly, may we share hospital results with the entity we rent from, rather than the individual hospitals?

Each hospital must receive results. Either the organization must provide results to each hospital or it may have a written agreement with the national network stating that it will provide results to hospitals. If the national network provides results to each hospital, it must provide documentation (e.g., reports, materials) to the organization that it has met the requirements.

This applies to the following Programs and Years:

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 Methodology for evaluation of cost measures What constitutes an acceptable methodological approach to evaluation of cost?

NCQA does not prescribe the cost measures an organization selects, though it requires an organization to specify all aspects of its methodology (Element C). In addition, the organization must risk-adjust its measures (Element C, factor 8) and must meet the minimum statistical requirements for measurement error and measure reliability (Element H, factor 2).

This applies to the following Programs and Years:

11.17.2008 Acceptance of HIP 6 for Autocredit of PHQ 2 Will NCQA accept HIP 6 for autocredit for PHQ 2008?

Yes. The substance of the standards did not change and the purpose of HIP is to give autocredit.

This applies to the following Programs and Years:

9.15.2008 Providing Results and Estimates of Statistical Reliability Element F, factor 3 requires organizations to provide results and estimates of statistical reliability for comparative information to each physician. What evidence must organizations provide to meet factor 3?

To meet the intent of factor 3, the organization must provide physicians with the results of each applicable measure and an estimate of statistical reliability. The organization determines how it expresses the estimate of statistical reliability (e.g., range, standard deviation, confidence interval, coefficient of variation). The organization should also provide descriptive information with the numbers; the estimate of reliability is a numeric value.

This applies to the following Programs and Years:

9.15.2008 Standardized Measure Specifications For Element A, if physicians may eliminate noncompliant patients as part of the corrections process, are standardized measures still considered to be nationally recognized?

If a patient is removed from a measure for not taking prescribed medication or for not following recommended treatment, the measure is not considered standardized. If the patient meets specific exclusion criteria listed in the specifications and is removed from the measure, the measure is considered standardized.

This applies to the following Programs and Years:

9.15.2008 Applications for PHQ surveys How long after NCQA receives an application for survey does the survey begin?

NCQA suggests that organizations submit an application for survey at least 90 days in advance of the date requested for their Initial Survey, but applications may be submitted further in advance than 90 days. Organizations should indicate their preferred survey date and NCQA will accommodate them if possible.

This applies to the following Programs and Years: