TN 1 (07-15)

DI 39545.575 DDS Annual Consultative Examinations (CE) Oversight Report

Citations:

20 CFR §§ 404.1519, 404.1519t

A. DDS Annual CE Oversight Report Overview

The DDS Annual CE Oversight Report captures substantive data and facilitates meaningful national and regional analyses. In addition to CE oversight, it captures information about other medical/professional relations activity. This is an annual (federal fiscal year) oversight report covering the preceding 12-month period.

The DDS:

  • submits the Annual CE Oversight Report and ancillary information for the federal fiscal year (October 1st of prior year to September 30th of current year) using the fillable form on the ODD MPRO SharePoint site; and

  • provides a list of CE providers, and the CE/MER fee schedule within 45 days following the end of the federal fiscal year (no later than November 15).

Contact your regional Professional Relations Coordinator to obtain permission to access the ODD MPRO SharePoint site.

B. Procedures for the DDS CE Oversight Report

The DDS will include the following elements and follow the submission instructions listed:

  1. Include all the following elements in the DDS Annual Oversight reports:

    1. Provide a brief description of the DDS’s procedures used to resolve the various categories of complaints received throughout the year. Include a description of the types of complaints received throughout the year.

    2. Provide a description of any fraudulent activities discovered throughout the year by CE Providers, and include the outcome.

    3. Identify complaints received of an egregious nature requiring either or both significant corrective action and public relations work per DI 39545.375.

    4. Provide a brief description of the DDS business process to ensure:

      • State license and federal credential checks are completed timely (checks should be made at the initial agreement and at frequent intervals thereafter).

      • CE provider’s support staff is properly licensed and credentialed, required by State law or regulation.

    5. Indicate how frequently throughout the year credential checks were completed. If credential checks were not completed, provide explanation.

    6. Provide a brief description of the DDS business process to review CE reports from new and established CE providers to ensure the reports meet criteria.

    7. Provide the total number of providers on the CE Panel and describe any differences from the previous year.

    8. Indicate whether all Key and Volume provider onsite visits were complete. (For clarity on who is a Key and Volume provider see DI 39545.100) If not, provide and explanation.

    9. Provide a description of any CE and MER fee schedule changes and all exceptions.

    10. Provide a brief description of the DDS medical and professional relations officer’s activities regarding marketing electronic records, exhibiting at medical conventions, joint actions with Regional public affairs offices and any other pertinent information.

  2. Upload the following information to the ODD MPRO SharePoint site:

    1. A list of all CE providers who performed CEs in the previous fiscal year to the “DDS CE Provider List” section of the ODD MPRO SharePoint site:

      • Indicate Volume and Key providers (note whether Key provider is one of top five or based on primary CE work).

      • Indicate CE panelist that you removed because of inactive license, sanction, or removal for cause and note the reason(s).

      • Indicate CE providers for whom you completed onsite reviews.

    2. A copy of the current CE and MER fee schedules to the “DDS Fee Schedules” section of the ODD MPRO SharePoint site annually.

  3. The DDS provides written notification to the regional office when they submit the CE Oversight Reports

NOTE: For decentralized DDS locations, the submitting locations should provide a consolidated list separated by each branch (e.g., separate tabs).


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