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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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)
Certification in PHQ, PQ or HQ is valid for two years. Organizations must undergo a survey against the standards at least every two years to maintain their certification status. Provisional Certification is valid for 12 months; it is a temporary option and will not be offered after June 30, 2009.
NCQA does not evaluate coding accuracy and quality. Element D, Verifying Accuracy requires an organization to have a process to evaluate the accuracy of its measure results. The organization may use external auditors to verify its methodology, but is not required to do so. In the future, NCQA may develop standards for auditing physician measurement and a program for certifying auditors. With such standards, NCQA will consider making external audit a requirement.
No. Survey prices apply to each discrete survey; NCQA does not apply credit forward to a future survey. Survey pricing reflects the amount and level of resources NCQA dedicates to evaluating an organization and at the time of the Full Certification Survey, NCQA must re-evaluate the organization on all requirements.
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.
There is no minimum requirement. If the total number of files is fewer than the requested 40 files, NCQA reviews the entire file universe. For file review elements, NCQA follows its 8/30 methodology. Refer to An Explanation of the 8 and 30 File Sampling Procedure on the NCQA Web site at www.ncqa.org/tabid/125/Default.aspx.
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.
NCQA recognizes that some NQF-endorsed or AQA-approved specifications may require additional specifications to implement in specific contexts. Organizations may supplement endorsed specifications as long as they follow all endorsed specifications and if such supplementation does not alter the intended numerator, denominator and exclusion criteria for the measure.
