Organizations must report all IDSS data elements for any hybrid measure they report using their audited HEDIS 2019 hybrid rate.
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.
The discharge date from the index hospital stay should be used for reporting. The PCR measure assesses the number of acute inpatient and observation stays during the measurement year that were followed by an unplanned acute readmission. SNFs are considered to be nonacute inpatient settings. Therefore, when a member is transferred from an acute inpatient setting to a SNF, only the acute inpatient stay is assessed for reporting.
For example, a member has an acute inpatient stay February 1 – 5 and was discharged to a SNF February 6 – 9 and then transferred back to acute inpatient care February 10 – 14. There are two acute inpatient stays which are assessed for the PCR measure and count as two index hospital stays for the denominator (Stay 1 is February 1 – 5, Stay 2 is February 10 – 14), provided they meet all other measure criteria. Stay 2 is a readmission for Stay 1, provided it meets all numerator criteria because it occurs within 30 days of the discharge date for Stay 1. Stay 1 counts as an index hospital stay discharged to a SNF.
The tables in the PDF (https://www.ncqa.org/wp-content/uploads/2020/03/20200312_2020_PCR_Tables.pdf) illustrate assignment of risk weights for index hospital stays among two hypothetical Medicare beneficiaries meeting all other measure criteria (e.g. non-outlier, continuously enrolled, etc.). Index Hospital Stay #2 for member 1101 and Index Hospital Stays #1 and #2 for member 1202 are discharged to skilled nursing care.
Table 1 shows that these index stays are assigned the standard set of risk weights for reporting in Table PCR-A-1/2/3 and Table PCR-B-3. Do not assign the skilled nursing care risk weights for the stays in Table PCR-A-1/2/3 and Table PCR-B-3.
Table 2 shows that these same index stays are assigned the skilled nursing care risk weights for reporting the “Skilled Nursing Care Stratification” in Table PCR-C-3. Do not assign the standard set of risk weights for the stays in Table PCR-C-3.
Index hospital stays that are not discharged to skilled nursing do not need to be assigned the skilled nursing care risk weights and are not reported in the “Skilled Nursing Care Stratification” in Table PCR-C-3. Index Hospital Stays #1 and #3 for member 1101 are examples of events that do not need to be assigned the skilled nursing care risk weights and are not reported in the “Skilled Nursing Care Stratification”. The “Skilled Nursing Care Stratification” applies to the Medicare product line only and index hospital stays among other product lines do not use the skilled nursing care risk weights.
No. Except as noted under “Related information: Extending the recredentialing cycle length,” where NCQA makes provisions for situations such as active duty military assignment and medical leave, the organization may not extend the 36-month recredentialing cycle. If the practitioner is not recredentialed within 36 months, the file will be scored down. There is no grace period for recredentialing.
If an organization missed the recredentialing deadline and intends to keep the practitioner in the network, files must be processed as follows:
Interpret that text to mean any combination of high and medium other than the scoring thresholds specified for “MET.”
For example, an organization must earn “high” on 7 factors to score MET on PHM 5, Element D; therefore, to score “PARTIALLY MET” for that element, it may earn “high” on 0–6 factors and “medium” on the remaining factors.