Effective Dates: 03/24/2016 - Present Previous | Next

Basic (10-09)

DI 30001.200 Quality Assurance Unit (QAU) Sample Case Reviews

A. Introduction

Ongoing QAU random review of completed cases is a fundamental part of a DDS QA system. Such a review is an efficient way to monitor DDS adherence to SSAs policies, procedures, and practices. The effectiveness of DDS training can also be evaluated.

B. Sample case review

The QAU should perform an ongoing internal review of a random sample of completed DDS cases.

1. Random sample

Identifies substantive and technical disability issues.

2. Monitoring case development practices

As part of the sample review, QA specialists should monitor practices such as:

  • •

    timely development actions;

  • •

    development of all alleged impairments

  • •

    contacts with treating sources;

  • •

    appropriate follow-up practices;

  • •

    appropriate consultative examination (CE) requests;

  • •

    use of treating sources for CEs;

  • •

    effective use of the telephone; and,

  • •

    awareness of unproductive medical sources.

3. Monitoring determinations and case explanations

QA specialists should review decision rationales and Medical Consultant assessments for issues such as:

  • •

    Addressing all impairments;

  • •

    Evaluating symptoms

  • •

    Evaluating and weighing opinion evidence; and,

  • •

    Applying proper vocational analysis at steps 4 and 5 of the Sequential Evaluation process.

For additional information about SSR 16-3p, see DDSAL 947.

4. Analysis of sample data

Data from random case reviews should be recorded and analyzed to identify problems or trends requiring management attention.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0430001200
DI 30001.200 - Quality Assurance Unit (QAU) Sample Case Reviews - 03/24/2016
Batch run: 03/24/2016
Rev:03/24/2016