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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1.24.2014 Evidence-Based Cervical Cancer Screening of Average-Risk Asymptomatic Women (ECS) Step 1 of the ECS Administrative Specification Rate 1 states, “Identify the number of women 24–65 years of age with hysterectomies who had cervical cytology.”

In the MY 2012 P4P manual, step 1 of Rate 1 in the ECS Administrative Specification says, “…who had NO Pap tests.” Should the text in the MY 2013 P4P Manual say, “who had NO cervical cytology”?

Yes. Step 1 of the ECS Administrative Specification Rate 1 should say, “…who had NO cervical cytology.”

This will be corrected in the next release of the manual.

IHA 2013

1.15.2014 Distribution of the Member's Rights and Responsibilities Statement May a delegate distribute the statement of members' rights and responsibilities?

Yes. Distribution of member rights and responsibilities statement by a delegate is acceptable. The organization must perform oversight to ensure that this requirement is met.

1.15.2014 Board Certification as Verification of Education and Training for Nurse Practitioners (NP) and Physician Assistants (PA) Is it acceptable to use ANCC and NCCPA board certification as verification of highest level of education for nurse practitioners and physician assistants?

Yes, if the organization can obtain written confirmation from the ANCC and NCCPA that they perform primary-source verification of the professional school training.

CVO 2013

12.20.2013 Asthma Medication Ratio (AMR) Step 1 in the Event/Diagnosis section of the Eligible Population criteria refers to Table ASM-C for identifying asthma medication dispensing events. There is no Table ASM-C in the specification.

The table for identifying asthma medication dispensing events was inadvertently left out of the December 2, 2013, version of the MY 2013 manual. Table AMR-B is identical to Table ASM-C in HEDIS 2014 Volume 2.

IHA 2013

12.20.2013 Supplemental Data Guidelines Have the dates been extended for primary source verification and final approval of supplemental data for P4P Measurement Year 2013?

Yes. Data collection and entry of all nonstandard and member-reported supplemental data must stop on March 3. Primary source verification and final approval must be completed by March 14, for member-reported supplemental data, and by March 28, for nonstandard supplemental data. Primary source verification may not occur before March 3 unless all supplemental data processes, collection and entry have stopped. Supplemental data approval and primary source verification may not occur, under any circumstances, before January 1 and receipt of the Roadmap.

IHA 2013

12.20.2013 Controlling Blood Pressure for People with Hypertension (CBPH) The CBPH measure is not listed in the P4P Value Set Directory. Where can we find the Value Sets for this measure?

The CBPH Value Sets can be found by filtering for Value Set Name in the P4P Value Sets to Codes tab of the P4P VSD file. The Value Sets for CBPH already exist as part of the CDC measure. The next release of the Value Set Directory will list the CBPH measure separately.

IHA 2013

12.20.2013 Evidence-Based Cervical Cancer Screening of Average-Risk, Asymptomatic Women (ECS) Step 3 of Rate 2 Underscreened does not specify what to do with the remaining population of women 30- 65 years with no hysterectomy who have no cervical cytology tests in the measurement year or two years prior to the measurement year and EITHER:
• Zero cervical cytology and HPV co-tests OR
• Two or more cervical cytology and HPV co-tests in the three or four years prior to the measurement year.

Could you clarify?

Per step 3 of Rate 3: Screened Too Frequently, a member with two or more cervical cytology and HPV co-tests in the third or fourth year prior to the measurement year is considered Screened Too Frequently.

IHA 2013

12.16.2013 General Guidelines Are HbA1c and LDL-C tests where the member collects a blood sample at home and sends it to a lab for results calculation allowed for HEDIS reporting?

No. Tests where the blood sample is collected by the member are considered self-administered tests and are not eligible for use in HEDIS reporting.

HEDIS 2014

12.16.2013 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Is a BMI growth chart sufficient for the physical requirement of the developmental history component?

No. Growth charts (height, weight, BMI or BMI percentile) do not meet criteria for physical developmental history for the W34 measure. The intent of the developmental history component (physical and mental) is to determine if the child was assessed for specific age-appropriate physical and mental developmental milestones, which are behaviors or physical skills seen in children as they grow and develop. For the W34 measure, examples of mental developmental milestones include ability to speak understandably, identify colors and define words appropriately. For the W34 measure, examples of physical developmental milestones include the ability to hop, throw a ball, draw and make a block tower. Documentation of "developing appropriately" or "normal development" meets criteria for both physical and mental development. Documentation of "growing appropriately" (without notation about "development") does not meet criteria for physical or mental developmental history.

Additional examples can be found in the Appendices of the Bright Futures Pocket Guide Guidelines for Health Supervision of Infants, Children, and Adolescents (http://brightfutures.aap.org/pdfs/bf3%20pocket%20guide_final.pdf).

HEDIS 2014

12.16.2013 General Guidelines If an organization finds an undated lab result in a progress note, can the progress note date be used as the lab result date?

No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.

HEDIS 2014

12.16.2013 Cervical Cancer Screening In step 2 of the Administrative Specification, organizations identify women 30-64 years of age as of December 31 of the measurement year who had cervical cytology and a human papillomavirus (HPV) test, with service dates four or less days apart during the measurement year. When counting service dates, is the date of the cervical cytology considered day one or day zero of the four-day count?

The date of the cervical cytology is considered day zero. For example, if the service date for cervical cytology was December 1 of the measurement year, the HPV test must include a service date on or between December 1 and December 5 of the measurement year.

HEDIS 2014

11.15.2013 General Guidelines If a member is included in a measure's denominator due to an incorrect code, may a corrected claim be submitted to remove the member from the measure?

It is not NCQA's policy to dictate an organization's claims submission process. Claims may be corrected or updated as necessary before the HEDIS reporting process begins. However, once the HEDIS reporting process has begun (i.e., the measures' eligible populations are identified and samples are drawn for hybrid reporting), the requirements specified in Volume 2 General Guidelines and Technical Specifications must be followed.

For administrative-only measures, members who meet the eligible population criteria for the measure should remain in the measure. If an organization refreshes data for administrative-only measures, the most accurate and current information must be used for reporting. Additionally, the organization must apply the refresh to all applicable measures.

For hybrid measures, members who are in the denominator due to inaccurate claims data may meet criteria for a valid data error. Valid data errors are identified only for hybrid measures during medical record review and may not be identified using supplemental data. In order to categorize a member as a valid data error (and replace the member with another member from the sample), the chart must show no evidence of the diagnosis and must include evidence to explain or substantiate the data error. As described in General Guideline 40, organizations that elect to refresh data for the sample may not use the refreshed data to change the hybrid sample after it has been selected. The auditor reviews all valid data error exclusions during Medical Record Review Validation.

HEDIS 2014