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.

Filter Results

Save
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Email
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Print
Print this page.
Share

expand all

12.11.2014 Meaningful Use of Health IT The first bullet of the September Updates on page 154 of the MY 2014 P4P Manual states, “Starting in MY 2014, the use of a survey tool for collecting the Meaningful Use of Health IT (MUHIT) domain will be discontinued; POs will be assessed based on data publicly available from the CMS Medicare and Medi-Cal Meaningful Use Incentive programs. Only participation in these incentive programs will count as credit for the P4P MUHIT domain.”
Is this correct?

Yes. Starting in MY 2014, self-reporting POs are no longer expected to complete a survey to receive credit for Meaningful of Use of Health IT. Participation in Meaningful Use will be assessed by P4P staff using publicly available files from CMS Medicare and Medi-Cal Meaningful Use Incentive Programs. P4P staff will solicit provider NPI lists from all POs in order to assign credit.

IHA 2014

11.17.2014 Paragraph missing concerning when UM time of requests begins in UM 5, Element C The following paragraph is included in UM 5, Element A, but not in UM 5, Element C. Should it be?

“The decision and notification timeframe begins upon receipt of the request. An organization may have procedures for ongoing review of urgent concurrent care it has approved initially. For ongoing review the notification period begins on the day of the review. NCQA requires the organization to maintain the date of the ongoing review and decision in the UM denial file.”

Yes. The explanation and requirements should be included in UM 5, Element C.

11.14.2014 Osteoporosis Management in Women Who Had a Fracture CMS required the use of temporary HCPCS code Q2051 (Injection, Zoledronic acid, 1 mg) from July 1–December 31, 2013. This code is not included in the Osteoporosis Medications Value Set. May organizations map this code and use it for HEDIS 2015 reporting?

Yes. Organizations may map Q2051 to J3489 (which is included in the Osteoporosis Medications Value Set and is for the same medication and dose) for HEDIS 2015 reporting. Auditors review mapped codes as part of the HEDIS Compliance Audit.

HEDIS 2015

11.14.2014 CAHPS Health Plan Survey 5.0H, Child Version To collect results for Children With Chronic Conditions, more than 12 questions must be added to the CAHPS child survey. How can an organization collect results for the Children With Chronic Conditions (CCC) measure without exceeding 12 supplemental questions?

A version of the child survey that includes the CCC questions is part of HEDIS. If an organization uses the “With CCC” version of the questionnaire, the CCC items are considered part of the CAHPS 5.0H questionnaire and are not included in the count of 12 supplemental questions.

HEDIS 2015

10.15.2014 Controlling High Blood Pressure Must organizations confirm the diabetes flag through medical record review? Should only administrative data be used to assign the diabetes flag that is used to assess the numerator?

Organizations are not required to identify or confirm the diagnosis of diabetes through medical record review; only the hypertension diagnosis must be confirmed. Only administrative data should be used to assign the diabetes flag. The intent of the flag is to determine the appropriate BP threshold to use for the member during numerator assessment because the threshold for members with diabetes is different from the threshold for members without diabetes.

The only exception is if the member is flagged as a diabetic but medical record evidence contains information that classifies the member as a valid data error. To meet criteria as a valid data error, the medical record must contain no evidence of diabetes and include a notation that refutes the diagnosis, as described in Substituting Medical Records in the Guidelines for Calculations and Sampling. In this case, the diabetes flag may be changed to “not diabetic”, but the member may not be removed from the sample.

HEDIS 2015

10.15.2014 Documentation requirements for Medicaid, Medicare and Marketplace product lines Under the 2015 Health Plan Standards and Guidelines, if an organization is bringing through its Medicare, Medicaid or Marketplace product line, what are the documentation expectations for the look-back period?

For certain elements with frequency or analysis requirements, (i.e., MEM 1 Element G; MEM 2 Element C; MEM 4 Element C; MEM 5 Element C; MEM 5 Element D; MEM 7 Element C, factors 3 and 5) the documentation requirement will be limited to a documented process for the Medicare, Medicaid and Marketplace product lines.

10.15.2014 Flu Vaccinations for Adults Ages 18-64 Will NCQA publicly report the Flu Vaccinations for Adults Ages 18–64 (FVA) measure for the Medicaid product line for HEDIS 2015?

Yes, the FVA measure will be publicly reported for the Medicaid product line for HEDIS 2015.

HEDIS 2015

10.15.2014 Relative Resource Use for People With Asthma Should the same change be made to the RAS measure that is also made to step 2 in the Event/Diagnosis section of the ASM, MMA and AMR measures in the HEDIS 2015 Volume 2: Technical Update?

Yes. In the Eligible Population section, replace the text in step 2 with the following: A member identified as having persistent asthma because of at least four asthma medication dispensing events, where leukotriene modifiers or antibody inhibitors were the sole asthma medication dispensed in that year, must also have at least one diagnosis of asthma (Asthma Value Set), in any setting, in the same year as the leukotriene modifier or antibody inhibitor (i.e., the measurement year or the year prior to the measurement year).

HEDIS 2015

10.15.2014 Osteoporosis Management in Women (OMW) The OMW measure’s Osteoporosis Medications Value Set varies from HEDIS. HEDIS includes the HCPCS code J1000; the P4P measure does not include the code. Which value set should we use for the MY 2014 P4P OMW measure?

The HCPCS code J1000 was deleted from the Osteoporosis Medications Value Set (refer to the HEDIS Volume 2 Technical Update memo released October 1, 2014, at www.ncqa.org). The update aligns the HEDIS OMW value sets with the September release of the P4P OMW value sets. We included these updates in the September release of MY 2014 P4P to reduce the edits that P4P organizations must apply with the December release.

IHA 2014

10.15.2014 Value Set Directory The October 1 version of the Value Set Directory (VSD) was rereleased on 10/8/14. What changed?

There were mislabeled columns on three of tabs on the October 1 release: Volume 2 Value Sets to Codes; Summary of Changes—Codes; Summary of Changes—Value Sets. In all of these spreadsheets, the first column should be labeled “Value Set Name,” not “Measure ID.” This was corrected in the updated VSD released on 10/8/14. No changes were made to the value sets or codes.

HEDIS 2015

10.15.2014 Evidence Based Cervical Cancer Screening (ECS) The wording and example for the cervical cytology and HPV co-test date range do not match. The example (pages 100–101 of the MY 2014 P4P manual) states, “…if the service date for cervical cytology was December 1 of the measurement year, then the HPV test must include a service date on or between December 1 and December 5 of the measurement year.” If the date range can be four days prior to or four days after, the example should read, “…if the service date for cervical cytology was December 1 of the measurement year, then the HPV test must include a service date on or between November 27 and December 5 of the measurement year.”

Your example is correct. We will amend the example in the specifications for the final release of the P4P manual on December 1, 2014.

For P4P reporting, the cervical cytology and HPV test dates must be four days or fewer apart during the measurement year or the four years prior to the measurement year. We do not specify that the date of the HPV test must be after the cervical cytology test; if cervical cytology is four days or less after an HPV test, it is acceptable.

IHA 2014

10.15.2014 Chlamydia Screening in Women (CHL) There is a discrepancy in the Sexual Activity Value Set between HEDIS 2015, released July 1, 2014, and the MY 2014 P4P Manual released September 2, 2014. The codes appear to relate to a change in the HEDIS value sets (page 89 of the HEDIS 2015 Technical Specifications manual):
• Revised value sets used for event/diagnosis criteria to ensure that supplemental data (e.g., LOINC codes) are not used to identify the denominator. Deleted Pregnancy Tests Value Set and Chlamydia Tests Value Set from the event/diagnosis criteria and added appropriate (e.g., CPT, UB Revenue) codes from these value sets to the Sexual Activity Value Set.

The September 2 release of MY 2014 P4P Manual for measure CHL states that there are no modifications from HEDIS. The following codes are in the HEDIS “Sexual Activity Value Set” and are not in the IHA P4P “Sexual Activity Value Set”:
• CPT codes: 81025, 84702, 84703.
• UBREV code 0925.

P4P also includes the Pregnancy Tests Value Set in the denominator; HEDIS 2015 removed this value set and uses it only in the optional exclusions.

You are correct: The draft P4P manual states that there are no modifications from HEDIS. The differences you see are the result of anticipated P4P changes and updates to the Volume 2 CHL measure, per the HEDIS 2015 Volume 2 Technical Update released on October 1, 2014, at www.ncqa.org.

The HEDIS technical update changes aligns the HEDIS CHL measure specifications and value sets with the September release of the P4P CHL measure and value sets. We included these updates in the September release of MY 2014 P4P to reduce the edits that P4P organizations must apply with the December release.

IHA 2014