Health Information LineNCQA

NCQA Requirements: The Nine Most FAQs

By May 5, 2019 No Comments

Here at Fonemed we often get asked by organizations interested in our telehealth programs about NCQA requirements. There are number of reasons why folks ask about this question. However, in many cases, it is due to the fact that many payers across the county plan to pay practices a bonus for meeting The National Committee for Quality Assurance’s standards. In any case, we would like to present some of the most common questions we’ve received from providers interested in our telehealth services, so that they may feel more informed and confident when choosing a company to partner with.

The National Committee for Quality Assurance

First off let’s start off with a little background regarding the NCQA from their website.

The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda. NCQA’s programs and services reflect a straightforward formula for improvement: Measure. Analyze. Improve. Repeat. NCQA makes this process possible in health care by developing quality standards and performance measures for a broad range of health care entities. These measures and standards are the tools that organizations and individuals can use to identify opportunities for improvement.

As you can plainly tell, this is an organization that is very much committed to improving the quality of health care.

Frequently Asked Questions Regarding NCQA Requirements

So let’s get started by addressing some of the common questions we get here at Fonemed regarding NCQA requirements and our services.

Q: “Does your nurse call center meet NCQA requirements for Wellness and Health?”

Yes, as a URAC accredited nurse call center, Fonemed meets NCQA requirements in a couple of key respects. We offer wellness and prevention programs complemented by a health information line that is staffed by licensed nurses or clinicians in the state where they provide service. In fact, our nurses and clinical staff are available 24 hours’ a day, 365 days a year.

Q: “What about data security and secure transmission of patient health information (PHI)?”

We are very serious about PHI, and view patient privacy as an essential component of our clinical services. We deal with this matter on two fronts, both from the perspective of personnel and technology. Our organization secures Business Associate Agreements (BAA) with all clients who receive call reports to assure that HIPAA/HITECH requirements are followed to the letter. Furthermore, all of our nurses receive a full package of HIPAA/HITECH compliant communications and information tools and operate under strictly controlled physical environments that conform to HIPAA, HITECH, OSHA standards. Our policies and performance standards clearly govern the provision of telephone advice and the scope of advice under which guidance is provided. Each of our calls are recorded, allowing for subsequent monitoring and review by our Quality Management Team. Finally, from the technology standpoint, Fonemed maintains all records and call recordings for a minimum of seven years securely as mandated by HIPAA/HITECH standards. All PHI and recordings are stored in a secure database combined with redundant off-site backups.

Q: “What about the 24-hour turnaround time for calls to be returned by a nurse or clinician?”

Over 99% of calls are live answered within 30 seconds of the person hearing the recorded disclaimer. If a Registered Nurse is not available, the call will be transferred to a Health Service Specialist (HSS). In this case, the Health Service Specialist will take the caller’s information and submit to the nurse for callback. Callers are then informed to expect a callback from a Registered Nurse (licensed within their State) within an average of thirty minutes, although most callbacks are completed within 20 minutes.

Q: “What if my population has a large number of native Spanish speakers?”

No problem. Services are provided in English and Spanish at no additional cost. About 15% of our calls are in Spanish. Upon client request, callers requiring assistance in other languages can also be accommodated. Clients interested in other languages can benefit from our real-time interpreter services in these instances.

Q: “Can you track the health of our members with your service, and what about follow-ups?”

Absolutely. We produce a detailed encounter report following each triage call. These reports are then forwarded to the primary care physician or other HIPAA authorized entities via secure fax or a secure FTP site in XML, text or PDF or HL7 format. Our population health management platform facilitates outbound calling as well as 24/7 inbound triage and we do follow-up on specified cases and contact members when deemed medically appropriate. A member’s personal health record is always available to us and includes prior contact history.

Q: “We are required to track telephone and web statistics at least monthly, does your system do that? What else can you track?”

Since we developed our software we can report on virtually anything our clients are interested in. Typically, our client’s are interested in: 1.) Real-time encounter reports that are generated after each call, 2.) Aggregated Monthly/Yearly Reporting, and 3.) Complete monthly call lists. These are just a few of the most common types of reports requested.

Q: “What are some of the data points offered in the reports you issue to clients?”

This is totally up to the client, but here are few that are quite common.
• Percentage of Calls that Required Triage
• Average Triage Call Time
• Abandonment Rate
• Average Speed to Answer
• Highest Proportion of Calls by Age of Patient
• Most Calls by Day
• Most Calls by Hour
• Most Frequent Final Disposition

Q: “How do you evaluate member satisfaction concerning your health information line?”

NCQA expects that a health information line is evaluated at least once per year. We go a few steps further by constantly measuring performance and routinely calling back up to 5% of callers for quality assurance purposes.

Q: “NCQA is obviously very interested in constant improvement and regular evaluation. How does your organization consistently improve its standards around your offerings?”

Yes, they are, and so are we. In fact, our Quality Management (QM) Program is structured to ensure the proper credentialing, orientation, training, monitoring, supervision, and evaluation of clinical and non-clinical staff as well as the service provided. In addition to periodic call monitoring/auditing and benchmark reviews, we have established a number of initiatives to ensure our priorities for improvement are consistently met. These take many forms and often include: clinical in-service training sessions, professional development seminars, and other continuing education programs for our staff. We are always striving to improve our culture of life-long learners and dedicated care-givers.

Have Your Own Questions About NCQA Requirements?

This post was just a sampling of some of the most common questions we receive about how Fonemed can help meet NCQA requirements for our clients. Interested in learning more about our various telehealth programs? Want to learn more about how we can provide care and improve the health and wellness of your population? Contact us today!

ABOUT FONEMED

Since 1996, Fonemed has recognized the value of telehealth as a key tool in providing more accessible and coordinated care. If your organization is facing new challenges in transitioning toward a coordinated, integrated and value-based care delivery ecosystem that involves telehealth technology and service, we can help. Contact us today and learn how we can help your organization succeed in meeting NCQA Requirements.

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Author nuevanuevomd

Medical triage, telemedicine and telehealth solutions. Over 20 years of nurse phone triage platform services and Canada and United States' provider and company of choice.

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