DI 30001.200 Quality Assurance Unit (QAU) Sample Case Reviews
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 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.