Question

What does NCQA consider when they receive a MAC

Answer 1

NCQA considers several factors when they receive a MAC, including access to care, patient satisfaction, quality improvement efforts, and adherence to evidence-based guidelines.

Step-by-step explanation:

NCQA, which stands for National Committee for Quality Assurance, considers several factors when they receive a MAC (Managed Care Accreditation). The NCQA evaluates the quality of care provided by health plans and accrediting organizations. They assess factors such as access to care, patient satisfaction, quality improvement efforts, and adherence to evidence-based guidelines.

For example, when evaluating access to care, the NCQA looks at factors like appointment availability, wait times, and access to specialists and mental health services.

The NCQA uses a comprehensive set of standards and measures to assess the performance of health plans and accrediting organizations and to determine their level of accreditation.

Answer 2

NCQA considers data accuracy, HEDIS standards adherence, proper data adjustment, and certification integrity when reviewing a MAC submission, ensuring reliable reporting of healthcare quality measures.

Step-by-step explanation:

When the National Committee for Quality Assurance (NCQA) receives a Measurement, Adjustment, and Certification (MAC) submission, it considers various factors. These include the accuracy of the data reported, adherence to NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) standards for measurement, proper data adjustment for calculation of performance measures, and the integrity of the certification process by a licensed and approved auditor. NCQA's review process ensures that health plans are accurately reporting quality measures as they are an integral part of determining healthcare quality and efficiency.