Auto-Credit Woes

Using an NCQA accredited or certified vendor can lock in scores of 100% for many elements.  This is great news for organizations looking to improve their accreditation outcomes. 

In order for the auto-credit to apply, however, the delegation agreement must clearly describe which elements are delegated and the vendor’s accreditation or certification must cover the specific elements.   

For the former requirement, I suggest that the delegation agreement describe which elements are delegated using language that is as close to the wording of the NCQA standards as possible.  In addition, the accreditation manuals contain appendices that contain information on delegation.  These appendices include language that should be included in the delegation agreements for the auto-credit to apply.

For the second requirement, it is important to look at the specific standards and elements under which the organization was accredited or certified to know if you will be able to get auto-credit.  Disease management is one of the areas where the Managed Care Organization (MCO) and Health Plan Accreditation (HPA) standards have diverged from the Disease Management Accreditation/Certification standards.  Unless a disease management vendor was surveyed under standards that match those in the 2007 MCO or 2008 HPA standards, you won’t get auto-credit for all of the disease management elements.

If you delegate elements to an organization that are not covered under that organization’s NCQA accreditation or certification, remember that you are not relieved of oversight for those elements.  For example, you will now need to conduct a pre-delegation audit and an annual evaluation for the elements not covered under the organization’s NCQA accreditation or certification.