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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2.01.2024 Health Plan Ratings Medicare CAHPS and HOS Data Does Not Match CMS Data Why doesn’t my Medicare CAHPS and HOS data match what my vendor provided?

Using Medicare CAHPS and HOS data in HPR depends on yearly approval by the Centers for Medicare & Medicaid Services (CMS). Because the submission schedule for Medicare CAHPS and HOS measures differs from the HEDIS submission schedule, NCQA scores organizations using the previous year’s data and percentiles for measures in the CAHPS and HOS domain.

There are also calculation differences between NCQA’s Medicare CAHPS and CMS. For example, NCQA scores some items based on a two-question composite where CMS uses a three-question composite. CMS case-mixes CAHPS results, NCQA does not. NCQA uses top-box scoring for HPR, CMS uses linear mean scoring converted from a  0-100 scale.