FAQ Directory

Patients, caregivers or family members are not likely to request care management services unless they are health care professionals; however, caregivers or family members may acknowledge the patient’s inability to self-manage care or to follow clinician instructions, or a patient may acknowledge his or her own inability to manage care, and that might lead a practice to consider the patient for care management services.

For example, children of a widower who relied on his spouse to help him manage a chronic condition might alert the practice that their father cannot manage his care and that they are not in a position to provide help.

PCMH 2017

Practices use the patients identified in CM 02 as the denominator for criteria in Competency B. To earn credit for each criterion, practices must document the required information for at least 75 percent of those patients. For evidence, practices must either complete the Record Review Workbook or submit a report.

• Practices that submit the Record Review Workbook must provide an example of each criterion, demonstrating how providing information is documented in the medical record.
• Practices that submit a report must provide a report with at least three months of recent data showing the number of patients who had the criterion-specific information documented in their medical record (numerator) out of the total number of patients identified in CM 02 (denominator).

PCMH 2017

No. NCQA does not prescribe a percentage, nor does it expect patients to be seen by their selected primary care clinician for a specific percentage of visits.
 

PCMH 2017

No. The ACFP tool is a helpful resource for practices to use when considering and managing panel sizes. If the practice prefers to use another method that is perfectly acceptable if it performs the same function.
 

PCMH 2017

“Alternative clinical encounters” are scheduled clinical encounters between patient and clinician in lieu of a traditional, one-on-one, in-person office visit; for example:

• A scheduled telephone clinical visit.
• A scheduled clinical video chat visit.

PCMH 2017

The practice should set its own goal for continuity of patient visits with their selected primary care provider or care team and then monitor that percentage to evaluate its performance. The practice should set goals such as by percentage, number of visits, etc. for the frequency patients should be seeing their selected provider and then monitor to see how frequent they are meeting their goal. The practice should provide its report including the rate of visits for patients with their provider including the goal established.
 

PCMH 2017

Practices define “timely” advice after considering the needs of their population. Practices must submit their written policy for responding to calls and e-mails, which may categorize the types of requests and appropriate response times.
Practices must also monitor and demonstrate their documented process defining response times to a nonurgent message and a report summarizing response times.
 

PCMH 2017

Yes, this meets the requirement if the telehealth provider is a clinician, provides a scheduled appointment and has access to practice systems and the patient’s medical record.

PCMH 2017

No. Walk-in appointments are different from scheduled same-day appointments. Same-day appointments offer patients the opportunity to schedule a routine or urgent visit at a specific time to enable more patient-centered and convenient access; this prevents the need to wait for the next available clinician at the clinic.

PCMH 2017

Yes, if the phone service can provide after-hours access (AC 04) and can access the patient’s medical record either directly or through an available on-call provider with direct access (AC 12).
 

PCMH 2017

Documentation may be a screen shot demonstrating system capability. This could be multiple screenshots (one of the Web portal page and screenshots for each item) or one screenshot showing evidence of multiple capabilities required (requesting medication refills, appointments and requesting a referral or test) on an active website. Practices are also encouraged to demonstrate these capabilities with their evaluator during their virtual check-in.

PCMH 2017

Yes, members of the clinical staff (including clinicians and nurses) providing clinical care to patients (based on pertinent licensing laws) may be scheduled for an alternative appointment with a patient. These appointments are in place of those scheduled in the physical office and provided by telephone or other technology supported mechanisms. Visits with social workers, nutritionists, educators or pharmacists alone without an accompanying staff member administering clinical care would not meet the intent of the criterion.

PCMH 2017