Identification Number:
DI 39515 BASIC
Intended Audience:See Transmittal Sheet
Originating Office:DCO ODD
Title:DDS Quality Assurance Cases
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 395 – DDS Fiscal and Administrative Management

Subchapter 15 – DDS Quality Assurance Cases

Transmittal No. BASIC, 03/04/2024

Audience

ODD-DDS: ADM;

Originating Component

ODD

Effective Date

Upon Receipt

Background

The Office of Disability Determinations modified the instructions for Suggested Quality Assurance Activities. This transmittal provides an in-depth explanation of the types of reviews conducted by Quality Assurance to enhance the DDS’s understanding of the Quality Assurance process.

Summary of Changes

DI 39515.401 Suggested QA Activities

Subsection B - we provide examples and add policy links for the QA functions Case Reviews, Special Studies, Analyses, and Reports.

DI 39515.401 Suggested Quality Assurance (QA) Activities

A. Related procedure

Guides for designing and using the Quality Assurance (QA) functions are in sub chapter DDS Quality Assurance DI 30001.000.

B. Examples - QA Functions

1. QA functions may include:

  1. a. 

    Case Reviews

    • In-line reviews are an effective way of identifying quality problems before a final decision is made. Perform in-line reviews to ensure adequate development, including the need for additional evidence, consultative examination approval, and medical/psychiatric assessments. For additional information about in-line quality assurance, see DI 30001.015.

    • End-of-line review refers to reviewing a completed case. Ongoing random QA 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 SSA’s policies, procedures, and practices. For more information about QA reviews, see DI 30001.200.

  2. b. 

    Special Studies involve any structured analysis of data or information collected for the purpose of providing findings to improve conditions or resolve problems. Generally, the duration and scope of a special study is limited. For more information about special studies, see DI 30001.600.

    • Such studies can provide management with information about specific areas in DDS operation that affect resources, accuracy, and processing time.

    • Adjudicating sites perform case reviews on current areas of concern to monitor compliance to SSA policies. Involved cases may include:

      • continuing disability reviews(CDR)

      • high risk reviews

      • federal review returns

      • individual local problem areas

      • aged cases

      • special workloads such as presumptive disability decisions, quick disability determinations (QDD), military casualty cases (MC/WW), terminal illness (TERI), and compassionate allowances (CAL)

  3. c. 

    Analyses

    • Adjudicating sites may find patterns and opportunities for improving workload management and identifying policies and procedures that need clarification. Per Quality Assurance Unit (QAU) Analysis and Feedback, DI 30001.800.

      The QAU analysis is based on:

      • statistical data from QAU sample case reviews, high-risk case reviews, and special studies.

      • feedback from Social Security Administration (SSA) review components (OQR, RPC, etc.); and,

      • information from all other relevant sources such as audit findings or independent consultant reports.

    • The following resources may also be used for training and improving agency quality:

      • Data Trends Analysis

      • DQB Returns, see Adjudicating Component Actions on Deficient Cases, DI 30005.000.

      • Feedback from Social Security Administration (SSA) review components (Office of Quality Review (OQR), request for policy consultation (RPC), etc.)

  4. d. 

    Reports

    • Adjudicating sites review and utilize the following OQR reports as an additional training resource to target a larger area of deficiencies for the purpose of improving agency quality:

      • Deficiency Reports

      • Target Denial Review (TDR) Reports

      • Pre-Effectuation Review (PER) Reports

    • The QA unit may also generate internal reports related to specific types of reviews such as reconsideration or CDR case reviews


DI 39515 BASIC - DDS Quality Assurance Cases - 3/04/2024