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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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 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

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 Clarifying text in UM 6 standard description Must the organization consult with the treating practitioner for every UM decision?

No. The organization only needs to consult with the treating practitioner when it is necessary to gather additional information. The consultation is not reviewed in the file review.

10.15.2014 NA for certification program Does WHP 13, Element E (which requires annual measurement of the effectiveness of two actions addressing improvement opportunities) apply to organizations previously certified in health appraisals or self-management tools under the HIP Standards and Guidelines?

No. NCQA will score this element NA for organizations coming through for NCQA Certification for the first time under the 2014 WHP Standards and Guidelines.

WHP 2014

10.15.2014 Annual Monitoring for Patients on Persistent Medications (MPM) The measure updates on page 43 of the MY 2014 P4P manual state that the numerator specifications for ACE/ARB, digoxin and diuretic rates no longer allow a blood urea nitrogen therapeutic monitoring test to count as evidence of annual monitoring.
On page 45, numerator specifications for ACE/ARB state, “At least one serum potassium and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in the measurement year.”
Numerator specifications for digoxin state, “At least one serum potassium, at least one serum creatinine and at least one serum digoxin, and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in the measurement year.”

 Numerator specifications no longer allow a blood urea nitrogen test. Incorrect references to blood urea nitrogen therapeutic monitoring were inadvertently left in the P4P MPM measure specifications and should be removed. This update will be made in the December release of the MY 2014 P4P manual. 

 

IHA 2014

9.15.2014 Comprehensive Diabetes Care For the eye exam indicator, is documentation of hypertensive retinopathy treated differently from diabetic retinopathy? If there is documentation that a member was negative for hypertensive retinopathy in the year prior to the measurement year, is this compliant?

 Although the two diagnoses are clinically different, hypertensive retinopathy is not treated differently from diabetic retinopathy for the CDC measure. The intent of the eye exam indicator is to ensure that members with evidence of any type of retinopathy have an eye exam annually, while members who remain free of retinopathy (i.e., the retinal exam was negative for retinopathy) are screened every other year. If it is clear that a retinal or dilated eye exam was performed by an eye care professional in the year prior to the measurement year and there is documentation indicating that the member is negative for hypertensive retinopathy, this can count as compliant.

 

HEDIS 2015

9.15.2014 Policies and Procedures: Accreditation status and Evaluation Option selection If a Marketplace product line is added to an existing product line through the automatic accreditation add-on process, when the Marketplace product line comes through again, what evaluation option will it be reviewed under, and what status will be available?

An NCQA-Accredited organization that received automatic accreditation via the Marketplace Add-On process may have the Marketplace product line reviewed against the First or Renewal Evaluation Option at the time of its Renewal Survey.
The organization must submit separate Survey Tools for an option other than a Renewal Survey.

The available accreditation statuses, elements reviewed and look-back periods are specified in the standards and guidelines for the selected Evaluation Option. 

For First and Renewal Surveys, the accredited status is valid for up to 36 months.

9.15.2014 PHQ: Evidence for seeking input from consumer representatives What evidence must an organization provide to meet the requirement for seeking input from consumer representatives?

The organization must provide a documented process for seeking and receiving input from consumers or consumer groups, and provide reports or materials showing that feedback was solicited and received.
The solicitation must address measures included in the program and how information about physicians is reported.
NCQA defines “consumers” as a non-health care professionals who have, or would, utilize health care services. NCQA defines “consumer groups” as organizations that advocate for people who are actual or potential users of health care services.

PHQ 2013

9.15.2014 Osteoporosis Management in Women Who Had a Fracture Step 4 states to exclude members who received a dispensed prescription or had an active prescription to treat osteoporosis during the 365 days (12 months) prior to the IESD. Define “active prescription.”

 An “active prescription” means that a member has a surplus of medication to take from a prescription dispensed previously. Therefore, in step 4 (required exclusions), the member is excluded if a prescription was dispensed during the 12 months prior to the IESD, or prior to that time frame if the member has remaining pills to take in the 12 months prior to the IESD.

 

HEDIS 2015

9.15.2014 General Guidelines In the draft MY 2014 P4P Manual published in September 2014, there is no mention of whether to apply a “14-day” rule to administrative data for numerators that require more than one service. It does mention to apply this rule in the new HbA1c 2 tests numerator for Diabetes Care. Should we apply this to CIS and HPV for P4P, as we will do for HEDIS 2015?

 
The “14 day” rule was added to the CDC specification because P4P had not adopted HEDIS 2015 General Guideline 44 for the September release of the MY 2014 P4P Manual. The guideline will be adapted for P4P and added to the final version of the MY 2014 P4P Manual, which will be released on December 1, 2014. This guideline, like HEDIS, will also apply to the CIS and HPV P4P measures, along with the Two HbA1c Tests indicator in the CDC measure.

IHA 2014