DI 39545.100 Key and Volume Providers
DDSs are responsible for conducting reviews of key consultative examination (CE) providers. The Regional Office (RO) assists in these activities as part of its oversight role.
1. Key provider
A CE provider who meets at least one of the following conditions:
an estimated annual (fiscal year) billing to the Social Security disability programs of at least $150,000; or
practice of medicine, osteopathy or psychology is primarily directed towards evaluation examinations rather than the treatment of patients; or
does not meet the criteria in bullets 1 and 2 of this list, but is one of the top five CE providers in the State by dollar volume, as evidenced by prior year data.
2. Volume provider
Usually, but not necessarily, includes a CE provider with estimated annual CE billings of $150,000 or more.