NCQA Accreditation and Certification Surveys – Be Prepared

If you are thinking about NCQA accreditation or reaccreditation, PSN can help.

 Preparation for an NCQA accreditation or certification survey can be a struggle, but these three action items can dramatically reduce the preparation difficulties and increase an organization’s likelihood of success:

  1. Provide adequate resources: The NCQA standards not only address quality improvement, but they also address many other areas, too. Areas such as utilization management, provider relations, marketing, informatics, member services and support must be involved. These areas must be supported by senior management and must be given the training and time to devote to the survey preparation effort.  NCQA preparation should be done on a day-to-day basis as part of the normal course of doing business.  The NCQA standards not only establish a foundation for being a quality-focused organization, but can also be a guide to ensure that what activities should be done to promote the best care and services for members gets done. Only adequate resources in terms of number and experience can make this happen.
  2. You can never start too early: Many NCQA standards require an organization to demonstrate compliance over a number of years. It is advisable for an organization to start preparation activities three years prior to a Renewal Survey; two years prior to a First Survey and one year prior to an Interim survey, whenever possible. This will afford the organization time to make sure that structure and processes are in place and that required measurements and improvements can be demonstrated.
  3. Engage expert help: Preparation for an NCQA survey requires expertise in NCQA subject matter and complex project management skills. Often times the day-to-day working operations within an organization are complex and organizations oftentimes find themselves balancing multiple competing priorities. In addition, organizations find that there are multiple sets of requirements to which they must adhere such as state regulations, CMS requirements and NCQA Standards.  An NCQA consultant can help organizations find the common ground across the requirements and can provide recommendations for establishing effective project plans.  An NCQA consultant can also assess compliance with the NCQA Standards, provide recommendations for efficient preparation activities, and help track time lines and milestones. If considering the use of a NCQA consultant, make sure that the consultant is an NCQA surveyor. Only an NCQA surveyor will truly understand the NCQA process, the intent of the standards, the philosophy behind NCQA accreditation and certification.

Call or email us today to talk with a PSN consultant regarding your NCQA accreditation goals.

[email protected] or call 301-460-4089.

Written by: Ellen Pauley, RN, MSB. Ellen, one of PSN’s NCQA consultants, has been an active NCQA surveyor since 1991 and helped with the development of many of the NCQA Accreditation and Certification products. PSN is an industry-leader in NCQA accreditation services. 

About PSN: 

Professional Services Network, Inc. (PSN) is a woman and nurse-owned company with more than 25 years of successful healthcare staffing and recruitment, as well as accreditation consulting experience.  We can provide temporary and direct hire nurses and executive leadership in managed care, especially in utilization review, quality management and case management. We are also experts in staffing seasonal projects, such as HEDIS and EPSDT, ensuring only the most qualified nurses for the job. PSN maintains contact with an experienced pool of nurses, nurse leaders, quality improvement professionals and social workers who are available for work almost anywhere in the U.S.