Program Operations Manual System (POMS)
Basic (03-24)
DI 39515.401 Suggested Quality Assurance (QA) Activities
Guides for designing and using the Quality Assurance (QA) functions are in sub chapter
DDS Quality Assurance DI 30001.000.
B. Examples - QA Functions
1. QA functions may include:
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a.
Case Reviews
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In-line reviews are an effective way of identifying quality problems before a final
decision is made. Perform in-line reviews to ensure adequate development, including
the need for additional evidence, consultative examination approval, and medical/psychiatric
assessments. For additional information about in-line quality assurance, see DI 30001.015.
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End-of-line review refers to reviewing a completed case. Ongoing random QA 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 SSA’s policies, procedures, and practices. For more
information about QA reviews, see DI 30001.200.
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b.
Special Studies involve any structured analysis of data or information collected for
the purpose of providing findings to improve conditions or resolve problems. Generally,
the duration and scope of a special study is limited. For more information about special
studies, see DI 30001.600.
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Such studies can provide management with information about specific areas in DDS operation
that affect resources, accuracy, and processing time.
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Adjudicating sites perform case reviews on current areas of concern to monitor compliance
to SSA policies. Involved cases may include:
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continuing disability reviews (CDR)
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individual local problem areas
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special workloads such as presumptive disability decisions, quick disability determinations
(QDD), military casualty cases (MC/WW), terminal illness (TERI), and compassionate
allowances (CAL)
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c.
Analyses
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Adjudicating sites may find patterns and opportunities for improving workload management
and identifying policies and procedures that need clarification. Per Quality Assurance
Unit (QAU) Analysis and Feedback, DI 30001.800.
The QAU analysis is based on:
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statistical data from QAU sample case reviews, high-risk case reviews, and special
studies.
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feedback from Social Security Administration (SSA) review components (OQR, RPC, etc.);
and,
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information from all other relevant sources such as audit findings or independent
consultant reports.
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The following resources may also be used for training and improving agency quality:
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DQB Returns, see Adjudicating Component Actions on Deficient Cases, DI 30005.000.
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Feedback from Social Security Administration (SSA) review components (Office of Quality
Review (OQR), request for policy consultation (RPC), etc.)
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d.
Reports
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Adjudicating sites review and utilize the following OQR reports as an additional training
resource to target a larger area of deficiencies for the purpose of improving agency
quality:
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Target Denial Review (TDR) Reports
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Pre-Effectuation Review (PER) Reports
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The QA unit may also generate internal reports related to specific types of reviews
such as reconsideration or CDR case reviews.