PCMH CCE COMPREHENSIVE EXAM QUESTIONS AND
ANSWERS GRADED A+
✔✔If NCQA requests any aspect of PHI - ✔✔include only the minimum information
necessary to satisfactory the intent of criteria
✔✔if you have to submit PHI as best evidence - ✔✔only submit de-identified info and
examples
✔✔Prevalidated Vendor - ✔✔supports practice's transformation by allowing practice to
earn auto transfer credit for some criteria
✔✔Where can you access the prevalidated vendor list - ✔✔on ncqa.org website and in
QPASS
✔✔What does practice submit for annual reporting - ✔✔key data and documentation for
six PCMH concepts as well as for special topics
✔✔If practice misses its annual reporting date... - ✔✔recognition is suspended
✔✔Leeway period for annual reporting - ✔✔up to 3 months from original reporting date
to pay a reinstatement fee
✔✔If practice doesn't reinstate annual reporting after 90 days - ✔✔have to submit under
accelerated transform and pay full transform fees based on fee schedule at time of
submission
✔✔The Audit Process - ✔✔part of "succeed phase" sample will be audited to validate
evidence, procedures and attestations. Will be audited by specific criteria or random
audit.
✔✔Compliant Review Process - ✔✔1. review complaint & determine if recognized by
NCQA
2. determine if compliant is germane to recognition
3. obtain release to share complaint with practice or clinician if involves PHI and quality
of care
4. forward compliant to clinician or practice within 30 days with request that the clinician
or practice review and respond directly to individual filing the compliant and copy NCQA
on the response
5. review response to determine whether compliant was handled in accordance with
NCQA requirements and whether all issues raised in the compliant have been
addressed
✔✔Reporting Hotline or Fraud and Misconduct - ✔✔Toll- Free Telephone
website: www.lighthouse-services.com/ncqa
, email:
Fax: must include NCQA's name with report
✔✔How can the audit be completed? - ✔✔email, teleconference, webinar, onsite
✔✔Accepting Complaints - ✔✔NCQA accepts written complaints from members of
public including patients, members and practitioners regarding recognized clinicians and
practices
✔✔Annual Reporting - ✔✔1 year after recognition; submit to demonstrate that practice
is committed high quality performance and continues to enhance PCMH model
✔✔How can practice use a prevalidated vendor? - ✔✔obtain letter of product
implementation from vendor and attest it is using the pre-validated functionality
✔✔What does NCQA consider when they receive a MAC - ✔✔consider practice data,
existing recognition and distinction, expiration dates and criteria scores of recognized
practices involved in transaction
✔✔Who bears the cost of the review for a MAC - ✔✔practice does; cost and impact on
recognition is based on NCQA policies in effect at the time of evaluation
✔✔NCQA Investigation Activities - ✔✔1. request for a review of improvements identified
or implemented to improve performance submitted to any state or federal agency
2. telephone contact for gathering info or clarifying info
3. request for submission of documentation or reports to support compliance or
monitoring activities
4. conduct unannounced survey or require a virtual or onsite review
✔✔Discretionary Audit - ✔✔purpose is to validate appropriateness of an existing
recognition decision; reportable events or NCQA investigation can result in a
discretionary audit
✔✔Structure of Discretionary Audit - ✔✔1.address issues indicating that a practice may
not continue to meet NCQA requirements in effect at time of recognition
2. scope and content determined by NCQA
3. can be completed via email, teleconference, webinar or onsite review
✔✔When is Onsite Review Conducted for Discretionary Audit - ✔✔within 60 days of
notification that NCQA intends to do a discretionary
✔✔Cost of discretionary review - ✔✔borne by the practice and correspond to the
complexity and scope of review and NCQA pricing policies in effect at the time of the
survey
ANSWERS GRADED A+
✔✔If NCQA requests any aspect of PHI - ✔✔include only the minimum information
necessary to satisfactory the intent of criteria
✔✔if you have to submit PHI as best evidence - ✔✔only submit de-identified info and
examples
✔✔Prevalidated Vendor - ✔✔supports practice's transformation by allowing practice to
earn auto transfer credit for some criteria
✔✔Where can you access the prevalidated vendor list - ✔✔on ncqa.org website and in
QPASS
✔✔What does practice submit for annual reporting - ✔✔key data and documentation for
six PCMH concepts as well as for special topics
✔✔If practice misses its annual reporting date... - ✔✔recognition is suspended
✔✔Leeway period for annual reporting - ✔✔up to 3 months from original reporting date
to pay a reinstatement fee
✔✔If practice doesn't reinstate annual reporting after 90 days - ✔✔have to submit under
accelerated transform and pay full transform fees based on fee schedule at time of
submission
✔✔The Audit Process - ✔✔part of "succeed phase" sample will be audited to validate
evidence, procedures and attestations. Will be audited by specific criteria or random
audit.
✔✔Compliant Review Process - ✔✔1. review complaint & determine if recognized by
NCQA
2. determine if compliant is germane to recognition
3. obtain release to share complaint with practice or clinician if involves PHI and quality
of care
4. forward compliant to clinician or practice within 30 days with request that the clinician
or practice review and respond directly to individual filing the compliant and copy NCQA
on the response
5. review response to determine whether compliant was handled in accordance with
NCQA requirements and whether all issues raised in the compliant have been
addressed
✔✔Reporting Hotline or Fraud and Misconduct - ✔✔Toll- Free Telephone
website: www.lighthouse-services.com/ncqa
, email:
Fax: must include NCQA's name with report
✔✔How can the audit be completed? - ✔✔email, teleconference, webinar, onsite
✔✔Accepting Complaints - ✔✔NCQA accepts written complaints from members of
public including patients, members and practitioners regarding recognized clinicians and
practices
✔✔Annual Reporting - ✔✔1 year after recognition; submit to demonstrate that practice
is committed high quality performance and continues to enhance PCMH model
✔✔How can practice use a prevalidated vendor? - ✔✔obtain letter of product
implementation from vendor and attest it is using the pre-validated functionality
✔✔What does NCQA consider when they receive a MAC - ✔✔consider practice data,
existing recognition and distinction, expiration dates and criteria scores of recognized
practices involved in transaction
✔✔Who bears the cost of the review for a MAC - ✔✔practice does; cost and impact on
recognition is based on NCQA policies in effect at the time of evaluation
✔✔NCQA Investigation Activities - ✔✔1. request for a review of improvements identified
or implemented to improve performance submitted to any state or federal agency
2. telephone contact for gathering info or clarifying info
3. request for submission of documentation or reports to support compliance or
monitoring activities
4. conduct unannounced survey or require a virtual or onsite review
✔✔Discretionary Audit - ✔✔purpose is to validate appropriateness of an existing
recognition decision; reportable events or NCQA investigation can result in a
discretionary audit
✔✔Structure of Discretionary Audit - ✔✔1.address issues indicating that a practice may
not continue to meet NCQA requirements in effect at time of recognition
2. scope and content determined by NCQA
3. can be completed via email, teleconference, webinar or onsite review
✔✔When is Onsite Review Conducted for Discretionary Audit - ✔✔within 60 days of
notification that NCQA intends to do a discretionary
✔✔Cost of discretionary review - ✔✔borne by the practice and correspond to the
complexity and scope of review and NCQA pricing policies in effect at the time of the
survey
