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The Recognition Process

Getting OnBoard Part 2 During: Earn It. The Recognition Process. Start-to-Finish (S2F) Pathway Your Roadmap to Recognition. 3 PHASES. BEFORE: LEARN IT – Am I eligible? Can I make the commitment? Why would I want to do this?

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The Recognition Process

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  1. Getting OnBoard Part 2 During: Earn It The Recognition Process

  2. Start-to-Finish (S2F) PathwayYour Roadmap to Recognition

  3. 3 PHASES BEFORE: LEARN IT – Am I eligible? Can I make the commitment? Why would I want to do this? DURING: EARN IT– I am committed what do I need to do submit? What is required? AFTER: KEEP IT – I made it! How do I keep my recognition? What do I do if my practice changes? How do I promote my achievement?

  4. “During/Earn It” PhaseThe Nuts & Bolts of the Recognition Process

  5. First NCQA Software Used During the Recognition Process Online Application Account • One account per organization handles many applications, multiple sites. Used for PCMH (2011 & 2014), PCSP, CAHPS PCMH • Enter primary contact, demographic practice and clinician information • Sign BAA and program agreement • Resource library inside • One application precedes every ISS survey tool • Used to initiate Multi-Site approval • Used to initiate Add-Ons • Safeguard your user names and passwords

  6. Order free Online Application Account Organizations use the same Online Application Account for PPC-PCMH, PCMH, PCSP, and CAHPS-PCMH

  7. Start-to-Finish Multi-Site Process…Approval is Required

  8. What Are Multi-Site Surveys?(PCMH & PCSP) • Option for organizations or medical practices with 3 or more sites that share policies and procedures and electronic systems across all of their practice sites. • NCQA does not give organization-wide Recognition • A specified number of corporate (shared) elements are completed once for multiple practice sites in an additional survey tool • All other elements require responses at the site level • Any possible multi-site should attend the “Getting on Board” training for complete details

  9. What are Multi-Specialty Surveys?(PSCP ONLY) • Multi-Specialty organizations can be a single site or Multi-site practice • Both require NCQA approval • Request approval teleconference through Online Application • Multi-specialty eligible practices will submit examples from 3 or more specialties, including a mental health specialty, if present for specified elements • Conference call will discuss submission of individual specialty surveys versus multi-specialty surveys

  10. During | Earn It Start-to-Finish Step 8 Attend FREE Standards Training “The Rules of the Program” Free training each month • PCMH & PCSP Standards (2 part program) • Attend as often as you want • Recorded version of PCMH 2014 (Coming Soon) • Time to ask NCQA staff questions

  11. Transform Practice

  12. Transformational Prep Work Start-to-Finish Step 9 • Assess practice site against Standards & Guidelines • Document gap in performance and need for written documentation • Write, finalize, and implement new procedures • Implement EMR • Build EMR data to support reporting requirements • Procedures and EMR must be in place for at least 3 months before initial submission • Anticipate at least 3 - 6 months prep time • Procedures and EMR must be fully implemented at least 3 months before survey submission

  13. Now Prepare Your SubmissionStart-to-Finish Steps 10-13

  14. Software Training Start-to-Finish Step 10 Software Training • Online Application • Interactive Survey System (ISS) Tool • Training is Recorded - Attend anytime! • • Not available as a live monthly training • Demonstrates how to navigate and enter information into the software • Submit any questions or technical difficulties to assigned technical analyst

  15. Buy ISS Survey Tools • Interactive Survey System Tool • • Survey tool purchase is the first of 2 payments to NCQA for each practice site • Pay by check or credit card at $80 per survey license • Corporate and each site tool cost $80 • E-mail, fax, or mail printed order form with payment

  16. Buy ISS Survey Tools • Interactive Survey System Tool • Single site tools can be ordered on-line. Multi-sites need preapproval • 2 emails follow purchase acknowledging purchase and providing username, password and license number for each survey tool purchased • Order with the same practice name used in application • Manager and Analyst assigned after purchase

  17. Complete Your Online Application

  18. Complete Your Online Application Log in Online Application Click new or continue

  19. Completing your Online Application • Sign the Agreements electronically • Create a separate application for each site • Enter your clinician data for each site • Note: Punctuation and spelling matter • Do NOT enter ALL CAPS • Link your clinicians to each application – which clinicians are currently practicing at each site • Enter the ISS license # from your e-mailorder for each site – creates a link to the ISS tool • Submit each site application to NCQA • NCQA needs 5 business days to verify site prior to accepting ISS tool – NCQA will send you an e-mail

  20. Prepare and Submit ISS Tool

  21. NCQA Website: ISS LoginAccess to Survey Tool You can always access ISS from NCQA Website

  22. Using the Survey Tool Steps for the practice: • Organize supporting documentation • Respond to ALL factors • Build document library • Link documents to elements • Complete Organizational Background tabs • Review results

  23. Organize Supporting Documents • Create a folder on the hard-drive for documents the practice MAYwant to attach • Develop a checklist of documentation already used in the practice and documents that need to be prepared • Refer to standards and guidelines publication to identify that the practice is providing the expected documentation (see FAQs) • No Protected Health Information • Save a copy of the Record Review Workbook and Quality Measurement and Improvement Worksheet • NCQA advises a maximum of three (3) documents or fewer per element (averaged – some require more, others just one) • Consider putting multiple documents in one document for a single element in a logical order – tell your story

  24. Manage the Documents Use a unique naming convention • Use any organizing principle desired, for example: • PCMH 1 A—Name of Document.docx • PCMH 1 B—Name of Document.xlsx • Avoid file names with special characters (e.g. quotation marks, question marks, commas, apostrophes, ampersands) • Documents can be linked to multiple elements; no duplicates should be in the Document Library • Use text boxes and highlighting to identify important sections and briefly explain the importance

  25. Respond to All Factors Answer EVERY radio button even if the answer is No. If NA make sure to justify in Text/Notes area

  26. Build the Document Library • Assemble documents in a PC file • No Protected Health Information • Assign meaningful file names • Highlight and label contents to draw reviewer attention • Aim for 1- 3 attachments per element • Attach one document to several elements • Load up to 3 documents at a time into ISS Tool Library and rename • Link documents to relevant elements • Save • Document changes require reloading

  27. Link Documents and Enter Text for Explanations Click here to link documents Click here to enter explanatory text

  28. ISS Survey Tool Organizational Background Tab Inside the ISS Survey Tool

  29. ISS Organizational Background TabComplete Practice Site Information Attach more information about the practice. Give it a face to our reviewers.

  30. Complete Recognized Clinicians • List the practice’s clinicians with these current Recognitions for auto-credit: • Diabetes Recognition Program • Heart/Stroke Recognition Program • Back Pain Recognition Program

  31. Pre-submission Completeness Check • ISS Completeness Check Functionality • Shows incomplete elements • Multi-Site corporate tools will always show incomplete elements • Readiness of ISS Tool • Check complete score and level • Check Must Pass elements and critical factors • Check that documents are linked to elements • Verify Online Application was accepted, if not an error message will appear when trying to submit

  32. Reediness of ISS Tool Review • RESULTS: • Summarized & Detailed • Must Pass • Critical Factors • Meaningful Use

  33. Submit Program Fees and Surveys • Each practice site will have a separate application fee based on the number of clinicians that see patients at that site – this is the 2nd payment to NCQA • Find current fees, check cover sheet and credit card forms in Online Application payment tab • Applicable fees are those current on the day of submission • NCQA will contact you if payment is not received or correct when survey is submitted • Survey review is not initiated until full payment is confirmed • No time limit on survey submission

  34. The Review Process

  35. Recognition Review Process NCQA • Checks licensure of all clinicians for restrictions • Evaluates Survey Tool responses, documentation, and explanations by • Reviewer – initial evaluation • Executive reviewer – NCQA PCMH managers • Peer review – Recognition Program Review Oversight Committee member (RP-ROC) • Audit (5%) – by email, teleconference, or on-site audit

  36. Recognition Review Process NCQA • Issues final scoring decision and level to the practice within 30 – 60 days by email • Reports results • Recognition posted on NCQA Web site • Not passed - not reported • Mails PCMH certificate and Recognition packet

  37. NCQA Evaluation: Example Text/Notes Entry Reviewer Note Practice Note Justify all N/As In Text/Notes

  38. Receive Recognition Decision

  39. Recognition Decisions Recognition awarded at the practice site level • Level 1, 2and 3 • 3-year Recognition period • Denial of Recognition • PCMH score below 35 points • PCSP score below 25 points • One or more must pass elements <50% • Not made public or distributed to P4P • Manager sends auto email to practice’s primary contact • Levels reported to public; scores are not made public

  40. How to See Results in ISS To view final results, DON’T open the survey here. Open the survey here.

  41. NCQA Recognition Directory • Website Listing Includes: • Clinician name, title (MD, DO, NP, PA) • Practice name and address • Current Recognition • Recognition Program

  42. Certificates Name of Practice • Routinely sent within 3 weeks of Recognition • Site-level • Fee for replacements or additional certificates • Request at select Certificates

  43. The Multi-site or Multi-specialty Practices An Expansion of Start-to-Finish Steps 6 & 7

  44. Start-to-Finish

  45. How to Request Approval Submit Approval/Eligibility Requests through the Online Application Login to the Online Application Choose the account to work in Obtain an account through the NCQA website

  46. How to Request Approval Click to Submit a Multi-site Approval Request Answer the Eligibility Questions • NCQA sets up a teleconference with a Recognition Manager within several days • Preparation materials for the call are sent in advance • Manager will explain corporate elements, submission process, and answer any questions • Last day to submit for PCMH 2011 Approval Calls is June 15 • First day to request PCMH 2014 Approval call June 1

  47. Approval Request The system will ask practice to wait for a call from NCQA to schedule your teleconference

  48. Conference Call Agenda • Practice and NCQA must be on-line in the practice’s Application • NCQA’s Recognition Manager: • Confirms Multi-Site eligibility • Assesses organization’s ISS Tool naming convention • Reviews Online Application process • Explains potential Corporate and Site elements • Confirms estimated timing of submissions • Produces Multi-Site ISS Tool order form

  49. Approval Teleconference E-mail When teleconference is scheduled, practice receives documents via e-mail. SEE NEXT SLIDES

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