PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 044 – Quality AppraisalSubchapter 10 – RSI Claims Quality Appraisal SystemTransmittal No. 7, 01/23/2019
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.
Summary of Changes
GN 04410.040 Protesting Deficiency Citations- Rebuttals Title II
Subsection I - changed the email address for Kansas City from ||KC CPS to ^KC CPS Quality Review
The Office of Quality Review (OQR) uses the SSA-93 Quality Review Feedback Report to notify the field office (FO), processing center (PC), the Office of the Regional Commissioner (ORC), and the Associate Commissioner (AC) of the Office of Central Operations (OCO) (for PC 7 and 8) of findings that identify payment errors and informational items which require corrective action but do not affect the sample payment.
The purpose of the rebuttal process is to resolve case-related disagreements between OQR and operating components. This process ensures that issues are resolved systematically and objectively and that affected beneficiaries receive a correct benefit payment. Informal communications between OQR and the operating components are encouraged to expedite resolution.
The FO or PC may rebut a cited deficiency only if it meets the criteria for a rebuttable issue outlined in GN 04410.040C in this section.
Use the SSA-93 Quality Review website to submit a rebuttal to the reviewing OQR field site within 45 days of the date OQR transmitted the SSA-93.
Select “Rebuttal Request Sent to OQR” in the “Respond to SSA-93 Review” area of the detail screen on the SSA-93 website,
use the Comments box to explain the issue, and
scan all supporting material into the electronic folder and clearly indicate the location in the Comments box.
The SSA-93 website notifies the ORC/AC of OCO of the rebuttal request once submitted.
Delay corrective action only on contested deficiencies pending final resolution. Correct all non-disputed deficiencies cited on the case.
Only dollar deficiencies that affect the sample period’s payment cited by OQR are subject to the formal rebuttal process.
OQR identifies non-payment and informational items on the SSA-93. Informally resolve questions related to non-payment and informational items via email or telephone contact. The FO or PC should reconcile any item where a policy misinterpretation is involved. If necessary, OQR revises the quality review database to reflect an informal resolution. The FO or PC must document the case when the decision is that corrective action is unnecessary or one that differs from the original OQR findings.
Deficiencies cited by OQR not rebutted by the FO or PC under the rebuttal process described in this section are:
evidentiary deficiencies, and
all informational items.
If the FO or PC disagrees with a deficiency, follow the rebuttal process described in this section. Resolution of a rebuttal is possible at any level in this process. When all SSA components involved reach an agreement, the rebuttal is resolved. Encourage informal communications via telephone or email to expedite problem resolution. The FO or PC and OQR record the rebuttal decision on the SSA-93 Quality Review website.
If the PC or FO disagrees with a rebuttable deficiency finding, the PC or FO contacts the reviewing OQR office within 45 calendar days of the date of transmission of the SSA-93 feedback report to the SSA-93 Quality Review website.
If attempts to resolve the issue informally fail, the PC feedback coordinator or FO should use the SSA-93 website to submit a formal rebuttal as described in GN 04410.040B in this section.
To prevent the PC from initiating corrective action on FO caused errors in the rebuttal process, the FO should
contact the PC feedback coordinator via telephone or email;
inform the PC of their disagreement with OQR's findings; and
instruct the PC not to take action on the protested deficiency pending a resolution.
The SSA-93 website will automatically notify the appropriate ORC/AC of OCO of the first level rebuttal once submitted.
You can find contact information for OQR Field sites (AIPQBs) at OQR Field Sites.
If the AIPQB director agrees with the FO rebuttal (i.e., disagrees with the original position of OQR), OQR removes the deficiency from the OQR database. OQR notifies the PC feedback coordinator and the FO (if they initiated the rebuttal) of the decision. The PC feedback coordinator notifies all operational components.
If the AIPQB director believes an interpretation of policy is involved, the AIPQB will consult with Division of Title II Quality and Special Studies (DT2QSS) in central office to determine if a policy submittal to the Office of Income Security Programs (OISP) is appropriate before responding. Notify the PC feedback coordinator and the FO of the possible delay in responding pending a reply from OISP.
When the AIPQB affirms all or part of the error findings, the AIPQB provides an explanation of the decision and information about supporting documentation in the Comments box and transfers jurisdiction back to the FO or PC. The decision will explain the additional corrective actions the FO or PC needs to take.
If the FO or PC agrees with the AIPQB rebuttal decision, the FO or PC annotates the SSA-93 Quality Review website after all corrections are complete.
If the FO or PC disagrees with the AIPQB rebuttal decision, the FO or PC must update the SSA-93 website within 15 days to request a second level rebuttal. The rationale for the second level rebuttal request is required in the Comments box. The SSA-93 website sends an automated email to the RO with the rebuttal request and comments.
If, after review of the material, the ORC/AC of OCO agrees with the decision of the AIPQB they will explain the decision in the Comments box. The SSA-93 website sends an automated email to the FO or PC. The decision is final and the FO or PC must complete the corrective action. The follow-up process resumes until the FO or PC updates the SSA-93 website to show all actions are complete.
If the ORC/AC of OCO disagrees with the position of the AIPQB, the ORC/AC of OCO must submit a second level rebuttal on the SSA-93 website within 10 days. The ORC/AC or OCO must provide the rationale for the disagreement in the Comments box. The SSA-93 website sends an automated email to OQR headquarters (HQ) with the request and rationale for review.
If OQR HQ agrees with the rebuttal (i.e., disagrees with the original position of the AIPQB), OQR HQ will post the decision and rationale to the SSA-93 website, and an automated email is sent to the FO or PC, and the RO. OQR will take action to remove the error from the eQA Quality Review database.
If OQR HQ upholds the original decision, OQR HQ posts the decision and rationale to the SSA-93 website, which sends an automated email to the FO or PC and RO within 15 calendar days of the date of the second level rebuttal request.
The OQR HQ decision is final. If OQR HQ affirms or amends the deficiency, the FO or PC must take the corrective action. The case will return to the follow-up process until the FO or PC completes all corrections and updates the SSA-93 website.
After resolution of all rebuttal actions, the FO or PC takes corrective action within 90 days and updates the SSA-93 Quality Review website. The ORC/AC of OCO is responsible for ensuring that corrective actions are completed.
Refer to the chart for ORC/AC of OCO and PC addresses:
ORC, PC, and AC of OCO Contacts
||BOS CPS RSI SSI
||PHI MOS CTR PROG SYSTS
||ATL MOS CPS
||CHI ARC MOS CRSI SSI
||DA RO TAR Feedback Reports
|^KC CPS Quality
||SF MOS Programs Support Center
||SEA CPS RPST
||NY ARC PCO OAS NEPC
||PHI ARC PCO OSB OAS
||CHI ARC PCO OSB
||SF WNPSC OAS
^OCO OQA TAR SSA93