Program Operations Manual System (POMS)
DI 39545.525 Exhibit 1 – Suggested Protocol for DDS Onsite Reviews of Consultative Examination (CE) Providers
Name and address of facility/provider
Other office locations
Types of examinations conducted
Provider has performed consultative examinations (CEs) for DDS since
Provider contact name and phone number
Key provider or top five CE provider by dollar volume
Reason for visit
Safe location for claimants to travel
Public Transportation and Parking
Emergency Exit Signs
Secure location for medical records and computer records
Claimants greeted timely
On file at DDS
Does medical source speak any language other than English?
If so, which language?
What is maximum number of CEs scheduled per medical source per day per specialty?
What are minimum interval times that the CE provider schedules for an exam?
What is actual length of time for exams to be completed per visit?
Privacy and confidentiality of claimant information
How and from who is the claimant’s medical/psychological history obtained?
How much time does the medical source spend face-to-face with the claimant?
Does the source certify that assistants meet the appropriate licensing or certification requirements of the State?
Diagnostic and lab tests: Performed by (if by a non-physician, state performer’s qualifications)
Interpreted by (if by a non-physician, state the interpreter’s qualifications).
Turnaround timeliness, including both the results of the tests and interpretations.
Exit Interviews of Claimants
Does provider transmit CE report electronically? If so, fax, website, C:D, etc.
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DI 39545.525 - Exhibit 1 - Suggested Protocol for DDS Onsite Reviews of Consultative Examination (CE) Providers - 09/21/2007
Batch run: 01/27/2009