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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2.21.2024 KM 09 Is there a minimum percent threshold for KM 09 (diversity) reporting?

The expectation is that diversity data is collected from all patients in the practice. An overwhelming majority of the practice’s population should have diversity data on file. If this is not the case, the practice should annotate an implementation plan in the notes section of Q-PASS. This plan should include an expected timeline for improved performance.

Please note that diversity data should be collected directly from the patient/family/caregiver. Please refer to the Standards and Guidelines for acceptable response options for each aspect of diversity.
 

PCMH 2017

2.21.2024 AR-CM 1 (AR 2024) What is considered “total population” for AR-CM 1 (AR 2024)?

For AR-CM 1 (AR 2024), “total population” is defined as unique patients seen by the practice in the prior 12 months. The intent of this attestation is to provide a point of reference for the ratio of care managed patients to your practice-site’s total patient population.
 

PCMH 2017

2.15.2024 Indication of an FOBT Test for the Colorectal Cancer Screening Measure Is documentation of “Colon Screening,” “Colon Screen” or “Colorectal Cancer Screening” sufficient to be considered an FOBT if it was completed during the measurement year?

Yes. Documentation of “Colon Screening,” “Colon Screen” or “Colorectal Cancer Screening,” with screening dates during the measurement year, could indicate an FOBT, the least invasive test that would use this limited documentation.

HEDIS 2023

2.15.2024 Compliant Documentation of Colonoscopy for the Colorectal Cancer Screening Measure Is documentation of “c-scope," “colo” or “colon” sufficient to be considered a colonoscopy?

No. Documentation of “c-scope,” “colo” or “colon” alone is not specific enough to be considered evidence of a colonoscopy.

HEDIS 2023

2.15.2024 Use of Continuity of Care Documents (CCDs) Can CCDs from health information exchanges be used for medical record review?

No. The medical record review process for the hybrid data collection methodology requires that information be abstracted from the medical record. CCDs are not the same as the medical record; this includes CCDs received from health information exchanges. Note that because electronically exchanged CCDs may be used as supplemental data, they are subject to supplemental data requirements.

HEDIS 2024

2.15.2024 Provider Interaction with Admission/Discharge Information in the Medical Record for the Transitions of Care Measure For the Notification of Inpatient Admission and Receipt of Discharge Information indicators, is evidence that the provider reviewed the admission/discharge information required (i.e., is the provider required to sign or acknowledge the admission/discharge information after it is filed in the outpatient medical record)?

No. Evidence that the PCP or ongoing care provider reviewed the admission/discharge information is not required for these indicators. If the required information is filed in the outpatient medical record or shared EMR (accessible to the PCP or ongoing care provider) during the required time frame, this alone meets criteria.

HEDIS 2024

2.15.2024 ADT Feeds for the Transitions of Care Measure Does an admission notification documented in an ADT feed meet criteria for the Notification of Inpatient Admission and Receipt of Discharge Information indicators?

No. Admission/discharge notifications in the ADT alone do not meet criteria (even if the provider has access to the ADT) because ADTs are not considered the legal medical record.
Criteria are met if the provider documents ADT notifications in the appropriate outpatient medical record or shared EMR (accessible to the PCP or ongoing care provider) during the time frame specified in the measure.
 

HEDIS 2024

2.15.2024 FI-SNPs, HI-SNPs, IE-SNPs and HEDIS Reporting Are Facility-Based Institutional SNPs (FI-SNPs), Hybrid Institutional SNPs (HI-SNPs) and Institutional Equivalent-SNPs (IE-SNPs) treated the same as I-SNPs when reporting HEDIS?

Yes. FI-SNPs, HI-SNPs and IE-SNPs should be treated the same as I-SNPs for reporting. Because they are all types of I-SNPs, they are included in the I-SNP exclusion, and are excluded when
I-SNPs are excluded.

HEDIS 2024

2.01.2024 Health Plan Ratings Standards Only (Yes)/"Yes" Public Reporting How will I be listed for Ratings if I am “Standards Only,” I choose to submit data and say “Yes” to public reporting on the Attestation?

As long as you submit scorable rates for at least 50% of the HPR measures by weight, we will calculate and display your measure rates and a numerical overall Star rating (1-5) on the September 15 release of HPR on the NCQA Health Plan Report Card.

HPR

2.01.2024 Health Plan Ratings Release Date When will the Health Plan Ratings be publicly displayed?

NCQA's Health Plan Ratings will be publicly displayed on or around September 15 at NCQA's Health Plan Report Card, which can be found here: https://reportcards.ncqa.org/health-plans. 

HPR

2.01.2024 Advertise/Market Health Plan Ratings Scores How can I market or advertise my plan's 2024 Health Plan Ratings scores?

Please go to the 2024 Health Plan Ratings website (https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2024/), where we outline our Marketing Guidelines. Please note that this document is updated annually no later than early September. 

HPR 2024

2.01.2024 Health Plan Ratings Medicare CAHPS and HOS Data Does Not Match CMS Data Why doesn’t my Medicare CAHPS and HOS data match what my vendor provided?

Using Medicare CAHPS and HOS data in HPR depends on yearly approval by the Centers for Medicare & Medicaid Services (CMS). Because the submission schedule for Medicare CAHPS and HOS measures differs from the HEDIS submission schedule, NCQA scores organizations using the previous year’s data and percentiles for measures in the CAHPS and HOS domain.

There are also calculation differences between NCQA’s Medicare CAHPS and CMS. For example, NCQA scores some items based on a two-question composite where CMS uses a three-question composite. CMS case-mixes CAHPS results, NCQA does not. NCQA uses top-box scoring for HPR, CMS uses linear mean scoring converted from a  0-100 scale.

HPR