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.

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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    high risk reviews

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    federal review returns

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    individual local problem areas

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    aged cases

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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)

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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    Data Trends Analysis

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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.)

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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    Deficiency Reports

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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.