Menu

FAQ Directory: Patient-Centered Medical Home (PCMH)

Filter Results
  • Save
  • Email
  • Print

5.24.2018 KM 02 What if the patient answers “No” or does not want to provide information?

Medical records should clearly indicate that the patient has been asked about the specific item by including a notation that the patient answered “No” or declined to answer. Practices do not lose credit if the patient says “No” or declines to answer as long as it is documented. 

PCMH 2017

5.24.2018 KM 12 B What are examples of adult immunizations?

Examples of immunizations for an adult patient population include flu shots, pneumonia vaccine, shingles vaccine and tetanus.

PCMH 2017

5.24.2018 KM 02 What is the required frequency for a patient health assessment

NCQA does not prescribe a frequency; practices determine the time frame for conducting and updating patient health assessments according to a protocol that suits their patient population, aligns with evidence-based guidelines and allows for meaningful evaluation of data.

PCMH 2017

5.24.2018 KM 02 Is there a percentage threshold requirement for the 9 items within KM 02

No. The evidence required for KM 02 does not require a report. The practice should outline how it collects and documents this information in its documented process. For evidence of implementation, the practice can demonstrate its process during the virtual check-in, which may include sharing where the information is documented in the patient record.

PCMH 2017

5.24.2018 KM 17 May practices assess response only to medications treating a specific disease of interest?

No. Practices must ask about all medications prescribed to the patient and assess their efficacy, especially for patients identified in CM 01 as needing care management. Patients may have multiple comorbidities and medications, so it is crucial to evaluate their response and barriers to adherence for all medications prescribed to them.

PCMH 2017

5.24.2018 KM 10 How can we best collect language needs information from all patients in our large population?

Practices could use a variety of methods to collect language needs information on a large patient population. They may collect data from all patients and their families to create a report showing language needs or obtain data from an external source (e.g., data about the local community or its patient population). 

Patients who do not speak English and patients from racial/ethnic minority groups may be less inclined to provide this information. Care should be taken to request the information using methods that respect multi-cultural differences. 

Resource: NCQA’s 2010 Multicultural Health Care Standards (Abbreviated) E-Pub: http://store.ncqa.org/index.php/2010-mhc-standards-and-guidelines-electronic-pub.html  

PCMH 2017

5.22.2018 AC 06 What are “alternative clinical encounters”?

“Alternative clinical encounters” are scheduled clinical encounters between patient and clinician in lieu of a traditional, one-on-one, in-person office visit; for example:

  • A scheduled telephone clinical visit.
  • A scheduled clinical video chat visit.

PCMH 2017

5.22.2018 AC 06 Our practice has a contract with a telehealth company that provides primary care to patients when they cannot come into the office. Does this meet the requirement for an alternative clinical encounter?

Yes, this meets the requirement if the telehealth provider is a clinician, provides a scheduled appointment and has access to practice systems and the patient’s medical record.

PCMH 2017

5.22.2018 AC 06 A behavioral healthcare practitioner is integrated with our practice and provides telepsychiatry visits. Does this meet the requirement for an alternative clinical encounter?

Yes. NCQA accepts telepsychiatry visits as an alternative clinical encounter if the behavioral healthcare practitioner is at least partially integrated with the practice site (i.e., sharing at least partial access to the same systems and patient records).

PCMH 2017

5.22.2018 AC 07 Does a link to the practice’s Web page showing available practice activities meet the requirements for AC 07?

Documentation may be a screen shot demonstrating system capability. This could be multiple screenshots (one of the Web portal page and screenshots for each item) or one screenshot showing evidence of multiple capabilities required (requesting medication refills, appointments and requesting a referral or test) on an active website. Practices are also encouraged to demonstrate these capabilities with their evaluator during their virtual check-in.

PCMH 2017

5.22.2018 AC 11 Urgent care visits or visits during extended hours may not be available with a patient’s primary care clinician. Does NCQA require a particular percentage of visits must be with a selected primary care clinician?

No. NCQA does not prescribe a percentage, nor does it expect patients to be seen by their selected primary care clinician for a specific percentage of visits.
 

PCMH 2017

5.22.2018 AC 13 Is it mandatory to use the American College of Family Physicians mentioned in the guidance for determining panel sizes?

No. The ACFP tool is a helpful resource for practices to use when considering and managing panel sizes. If the practice prefers to use another method that is perfectly acceptable if it performs the same function.
 

PCMH 2017