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 Survey Pricing If we go through provisional certification and are then required to go through full certification within 12 months, does our organization get a reduced price?

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.

11.17.2008 Measure specifications Expand on the minimum denominator criteria for quality measures. Do you mean minimum observations per measure? Or minimum observations per provider? Or is that already in the requirements?

In measuring physician performance and distinguishing among peers, the organization is required to specify minimum observations or denominators for each measure on which the action is based. Denominators are patient observations, which may include multiple observations for an individual.

Criteria must be defined at the level on which action will be taken.

Note: This applies if the organization uses minimum observations rather than confidence intervals or measure reliability.

11.17.2008 Measure reliability If a plan demonstrates a different methodology for statistical validity, would the methodology be considered?

Element C, Measurement Methodology requires the organization to have a method for determining measurement error and measure reliability. Element H, Principles for Use of Results sets requirements for minimum observations or levels of measure reliability or confidence intervalsas applicable for quality and cost, resource use or utilization measures.

For calculating measure reliability for PHQ, the organization must use the method described in the Explanation in Element C under the subhead Measurement error and measure reliability. Measure reliability is defined as the ratio of the variance between physicians to the variance within one physician, plus the variance between physicians.

NCQA does not prescribe the method used to calculate confidence intervals because the appropriate method may vary based on the parameter (e.g., mean or proportion).

11.17.2008 Survey pricing How much does the PHQ Survey cost?

11.17.2008 Productivity measures Are productivity measures within scope? For example, number of visits per half day: does NCQA classify this as a utilization measure or as something else?

No. Productivity measures are out of scope for the 2008 PHQ standards. Quality, cost, resource use and utilization measures are in scope if the organization takes action based on them.

11.17.2008 Coding accuracy Is evaluation of coding accuracy and quality considered to be in scope for these measures?

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.

11.17.2008 Measure specifications Since NQF does not publish the actual code sets for all its measures, how does NCQA determine that an organization is following the measure specifications as written?

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.

11.17.2008 Changing measure specifications With regard to patient experience measures, may we use items from CAHPS-CG but change the referent time period? For example, not rating the last 12 months, but rating the last visit and changing the response categories accordingly?

No. Changing the referent time period materially alters the measure and would therefore not qualify as a standard measure for Element A.

Patient experience measures endorsed, developed or accepted by the NQF, AQA, AMA PCPI, national accreditors or government agencies may be used, but the organization must follow the measure or instrument specifications as written.

11.17.2008 Risk adjustment How is risk adjustment defined for quality measures?

Case-mix adjustment considers variations in the health of physicians populations, often defined by age and gender. Severity is a patients degree of illness for a specific mix of conditions (e.g., cancer stages), morbidity or comorbidity. Together, case mix and severity are often called risk. Risk can be either the risk for needing a mix of medical services (utilization and associated costs) or the patients likelihood of achieving a specific level of quality-related outcome.

Risk adjustment may not apply to quality measures, particularly process measures. For quality measures, NCQA requires the organization to demonstrate that it has considered whether to risk-adjust measuresand that it has an explicit methodology if it does and an explicit rationale if it does not. If the organization determines that case-mix and severity adjustment do not apply to a quality measure, it provides documentation that supports the determination. If the organization adjusts measures for case-mix or severity, it provides documentation describing the methodology used.

11.17.2008 Taking action on cost measures Is an organization prohibited from using cost efficiency if quality results are not available?

Yes. The organization may not take action based on cost, resource use or utilization results alone. This is a must pass requirement for certification and is consistent with the Consumer-Purchaser Disclosure Project Patient Charter.

The organization is required to consider quality in conjunction with cost, resource use or utilization when it takes action. To the extent that the organization develops and presents a composite score or rating using cost, resource use or utilization and quality measures, it must disclose the specific measures for each category and their relative weight when it determines the composite or rating.

11.17.2008 Exemption process for surveys Can you confirm the process for exemption for PHQ 1?

During the application process, the organization lists and briefly explains instances where it feels exemptions apply.

11.17.2008 Surveyors for PHQ certification What organizations will conduct surveys now or in the future? Only NCQA or, for example, would Licensed HEDIS Audit Organizations conduct them?

NCQA performs surveys on the PHQ standards, but may develop standards for auditing physician measurement and a program for certifying auditors. With such standards, NCQA will consider making external audit a requirement.