TN 25 (07-06)

GN 00605.521 Beneficiary Listing-Sample Selection

A. Policy

Use the eRPS to obtain onsite listings of all title II and title XVI beneficiaries for which the onsite institution is serving as representative payee.

B. Procedure

To produce the beneficiary onsite listings using eRPS:

Step

Action

1.

From the eRPS Home screen select the "Organizational Payee Search" link under Search/View/Update.

2.

From the Organizational Payee Search screen (MS INTRANETERPS 007.004), enter the institutions’s name.

3.

From the Organizational Payee search results, screen, choose the appropriate organization. The IND column will display an “O” for this payee. (See MS INTRANTERPS 007.010).

4.

Access the Selected List screen (MS INTRANETERPS 020.017) to obtain selected beneficiaries in the organization.

5.

From the Terminated Beneficiaries list screen (MS INTRANETERPS (020.018), select a couple of records terminated during the review period.

Compare these beneficiary listings with the lists obtained from the State/institution and note any discrepancies. If you are unable to resolve the discrepancies, include this as an issue for discussion during the scheduled onsite review.

From the beneficiary listings, the RO/FO will select the sample of beneficiaries to be reviewed. The sample should include enough beneficiaries to provide sufficient data for SSA to evaluate the payee’s performance and to determine whether the institution's practices conform with SSA’s policies on the use and conservation of benefits and the reporting of significant events. Therefore, the size of the sample should be about 10 percent of the total beneficiary population. Select a minimum of 10 beneficiaries up to a maximum of 25 beneficiaries.

Once the sample beneficiaries are determined, print out and review the MBR/SSR/PHUS for each of the sample cases to ensure the organization is currently receiving benefits on their behalf, and the data on the eRPS agrees with the data contained on the MBR/SSR/PHUS. In addition, request that the organization provide a list of SSA beneficiaries they serve and compare it to the eRPS listing. The listing should also be reviewed to ensure that in all cases where the onsite institution is payee, the Type of Payee (TOP) code is SLM.

NOTE: State onsite institutions will receive unnecessary annual accounting forms if the information on the MBR/SSR/PHUS is not correct. Any corrections/additions needed to the eRPS should be made in accordance with instructions contained in MS INTRANETERPS 019.006 and MS INTRANETERPS 020.001.

A sample of beneficiaries from the terminated list should also be selected for review. Include beneficiaries who are no longer in the payee's custody as well as beneficiaries who died during the review period. Out-of-hospital beneficiaries should be included to determine whether the institutional payee is using the funds to satisfactorily meet the needs of the beneficiary even though he/she is no longer within its physical custody. Ordinarily, most of the funds would go to the current custodian with some funds (minimum of $30 per month) being designated for the beneficiary’s personal needs.

A copy of the MBR/SSR/PHUS and listing of the sample beneficiaries in each institution to be visited should be prepared for each member of the review team prior to the review. A copy of the listing should be provided to institutional staff so that each beneficiary’s financial records can be retrieved for the review team’s use. The institutional staff (usually social service or nursing staff) can confirm whether a beneficiary is residing in the facility, his/her location, and alert the staff in the medical records department to make information available regarding those individuals who no longer reside in the institution. By distributing this listing in advance, considerable time can be saved in conducting the review. (See GN 00605.524B—Procedure – Conducting the Review.)