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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The e-measures are part of the MUHIT Domain, but the numerators and denominators will be collected as part of the Physician Organization Clinical Measure File Layout.
Health plans are not expected to report the measures, which will not be included in the Health Plan Clinical Measure File.
Any PO may report the measures, even if it does not self-report P4P clinical measures.
The measures are not subject to NCQA audit or measure certification.
IHA 2014
No. The changes for December 2014 was omitted from the final version of the MY 2014 P4P Manual. The Measure Updates for December 2014 should include:
In the “Who We Measure” and “Computing the Results” sections, specified that primary care physicians (MDs and DOs), including internists, family practitioners, GPs and pediatricians, will be the basis of the denominator for assigning credit.
IHA 2014
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
The eligible population for the measure is all women 24–64 years of age as of December 1 of the measurement year, except those that meet the required exclusion. The denominator for each individual reported rate is also the total eligible population.
The denominator for the step 1 rate is all women 24–64; the numerator for step 1 is all women who had two or more Pap tests in the MY or the two years prior.
The denominator for step 2 is all women 24–64. The numerator is those who had two or more co-tests in the MY or the four years prior.
The description of the three rates should read as follows:
IHA 2014
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
The logic for identifying a member with diabetes should be the same in CDC and CBPH: At least two ED visits are needed. The bullet on page 64 of the P4P manual was inadvertently placed in the “Event/diagnosis” section. The specification should read:
Claim/encounter data. Members who met any of the following criteria during the measurement year or the year prior to the measurement year (count services that occur over both years):
· At least two outpatient visits (Outpatient Value Set), observation visits (Observation Value Set), ED visits (ED Value Set) or nonacute inpatient encounters (Nonacute Inpatient Value Set) on different dates of service, with a diagnosis of diabetes (Diabetes Value Set). Visit type need not be the same for the two visits.
· At least one acute inpatient encounter (Acute Inpatient Value Set) with a diagnosis of diabetes (Diabetes Value Set).
This change will be reflected in the December release of the MY 2014 P4P Manual.
IHA 2014
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
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
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
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
