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
  • Email
  • Print
expand all

12.11.2014 Meaningful Use of Health IT In the MUHIT Overview section, no changes are listed under the Measure Updates released in December for P4P MY 2014. Is this intentional?

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 “Computing the Results” section, clarified that IHA will solicit NPI lists from either POs or health plans.
  • 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.

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.

This applies to the following Programs and Years:
IHA P4P

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. 

This applies to the following Programs and Years:
IHA P4P

12.11.2014 Cervical Cancer Overscreening (CCO) The specifications indicate that three rates are reported (two rates for steps 1 and 2 and a total rate). The measure description describes each rate but it is unclear what the denominator for each rate should be. Are the denominators the same for the three rates?

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:

  • Women age 21-64 with more than one cervical cytology performed every three years (denominator is the total eligible population).
  • Women age 30-64 with more than one cervical cytology/HPV co-test performed every 5 years (denominator is the total eligible population).
  • Total rate (the sum of the two numerators divided by the eligible population).

This applies to the following Programs and Years:
IHA P4P

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:
HEDIS 2015

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.

This applies to the following Programs and Years:
HEDIS 2015

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.

This applies to the following Programs and Years:
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. 

 

This applies to the following Programs and Years:
IHA P4P

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.

This applies to the following Programs and Years:

10.15.2014 Diabetes Care (CDC) In the CDC measure (page 64 of the P4P manual), the ED Value Set was added to the “Event/diagnosis” section’s two-visit category. The ED Value Set is also listed for the single-visit category. The logic for identifying members with diabetes for CBPH (page 48 of the P4P manual) does not list a single ED visit as a way to identify a member with diabetes. Should the logic be the same in CDC and CPBH? If so, which is correct?

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.

This applies to the following Programs and Years:
IHA P4P

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:
HEDIS 2015