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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6.14.2018 CC 12 (Pediatric Specific) • AAP resource:

5.29.2018 QI 02B Are preventive care measures considered utilization measures?

No. Although effective preventive care can reduce future health care costs, preventive care measures address quality of care and are not utilization measures. Utilization measures address direct health care savings, in accordance with evidence-based guidelines.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 04B How do practices document providing pertinent demographic and clinical information to a specialist if they use the same EHR?

Practices must provide a documented process for staff to follow to ensure that demographic and clinical data are available for the specialist, and either a report/log or an example showing that the process is followed (e.g., a screen shot of available information and how the information is made available to the specialist). If external referrals are made, the practice must specify the process for sharing information with those providers, as well. 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 06 Are practices required to use an NCQA-Certified survey vendor to administer CAHPS PCMH?

No, practices are not required to use an NCQA-Certified survey vendor.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 01 What is the minimal information required to meet the requirements of the laboratory and radiology items outlined in CC 01?

There is no minimum data requirement. To meet this core requirement, practices must meet all six items outlined in CC 01. Practices must consider how best to demonstrate their process for each item to meet the intent as described in the guidance section of this criterion. 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 12 When remeasuring to show improvement, what is an acceptable period of time between the initial measurement and the follow-up measurement period?

NCQA does not specify a time period required for remeasurement, but it must be long enough for the practice to implement a performance improvement plan and to assess results.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 06 Does the CAHPS PCMH Survey meet both QI 04 and QI 06?

The CAHPS PCMH Survey meets the requirement for QI 06 but only partially meets QI 04. The CAHPS PCMH Survey only meets the quantitative data requirement (QI 04A) for this criterion.  
 

Note: No modifications to the survey questions or length may be made. 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 04A Are practices required to use the CAHPS PCMH survey to meet this requirement?

No. Practices may use any patient experience survey that includes questions related to three of the four categories specified in the standards (access; communication; coordination; whole-person care, self-management support and comprehensiveness).

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 11 May practices focus on improving the number of patient experience survey responses it receives back from patients?

No. A measure looking to increase the number of patients who complete the satisfaction survey would not meet the requirement. Practice should look at improving an area identified using the patient experience data collected in QI 04.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 04B May practices use the “comments” section in the patient experience survey to meet this requirement?

No. Comment sections or “free text” questions on a patient experience survey do not meet the requirement as a method of collecting qualitative feedback from patients and their families.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 12 How do practices assess the effectiveness of improvement actions?

Assessing effectiveness of improvement actions includes remeasurement to compare results over time and evaluation of what is driving change. Results may be quantitative (numerical data that demonstrate performance and can be compared to benchmarks) or qualitative (conceptual data that describe why performance is high or low), but practices must look at the goals set, actions taken to improve and previous or baseline results.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 05 How can practices stratify data for vulnerable populations?

Practices select a vulnerable population for measurement using fields that are available in their practice system. Practices may use categories such as race, age, ethnicity, language needs, education, income, type of insurance, disability or health status to identify specific populations that may experience disparities in care.

This applies to the following Programs and Years:
PCMH 2017