FAQ Directory: Patient-Centered Medical Home (PCMH)

Best Practices from NCQA’s Virtual Primary Care Program to PCMH:
The following elective criteria were written during the creation process of the new Virtual Care program, but found to be best practice for all primary care settings. For this reason, nine new elective criteria are added to the PCMH program.
 

Criteria	Criteria Title	Brief Description
TC 10	Patient Consent	The organization requests patient consent to treatment through virtual modalities.
KM 30	Prescribing Patterns	The organization tracks medication prescribing practices and performs analysis on prescribing patterns.
KM 31	Interpreter Services	The organization uses competent interpreter or bilingual services to communicate with individuals in a language other than English.
KM 32	Virtual Care Training	The organization provides staff training on relevant clinical and nonclinical topics.
AC 15	Appropriate Modality of Care	The organization has a process for determining that virtual care is appropriate for the patient.
AC16	Information for Appeals	The organization provides clinical information in response to appeals of denials based on medical necessity or treatment guidelines.
AC 17	Services Covered by Insurance	The organization has a process for informing patients which services are covered by insurance.
QI 20	Assessment of Clinician and Care Team Experience	The organization assesses clinician and care team experience for delivering care.
QI 21	Goals and Actions to Improve Clinician and Care Team Experiences	The organization identifies at least one opportunity to improve the clinician and care team’s experience, implements an intervention and measures the intervention’s effectiveness.

PCMH 2017