Identification Number:
GN 04410 TN 9
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:RSI Claims Quality Appraisal System
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 10 – RSI Claims Quality Appraisal System
Transmittal No. 9, 03/12/2020

Audience

PSC: BA, CA, CS, DE, DEC, IES, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, PETL;
OCO-ODO: BTE, CR, CST, CTE, CTE TE, DE, DEC, DS, PAS, PETE, PETL, RECONE, RECONR;
FO/TSC: CS, CS TII, CSR, CTE, DRT, OA, OS, RR, TA, TSC-CSR;

Originating Component

OQR

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

GN 04410.010 Retirement, Survivor, and Disability Insurance (RSDI) Quality Review

B.2. Changed OQR Field Reviewers hyperlink to Staff Directory hyperlink. Minor edits to comply with plain language requirements.

GN 04410.010 Retirement, Survivor, and Disability Insurance (RSDI) Quality Review

A. Introduction to RSDI quality reviews

The Office of Quality Review (OQR) monitors the quality of the RSDI program. OQR reviews determine payment accuracy and compliance with national instructions.

OQR uses the results from the ongoing reviews and special studies to:

  • Report to Congress on the financial health of the RSDI program;

  • Identify program policy and systems areas for corrective action; and

  • Assist other components in formulating operating policy.

B. Process for RSDI quality reviews

1. RSDI quality review

Below is a general overview of the RSDI quality review process.

  1. a. 

    The RSDI quality review verifies eligibility factors and determines the accuracy of payment amounts.

  2. b. 

    There are several ongoing reviews:

    • Stewardship is a review of ongoing Master Beneficiary Record (MBR) payments. Cases are selected from SSNs on which at least one RSDI beneficiary received a recurring payment.

    • Workers’ Compensation, Title II Postentitlement, Transaction Accuracy, and Work Continuing Disability Reviews target specific workloads under the RSDI program.

      NOTE: OQR also conducts special studies in specific program areas.

  3. c. 

    OQR selects a random sample of cases each month based on recently processed transactions or updates to the MBR. Quality reviewers in OQR field sites throughout the country review the selected cases.

  4. d. 

    The quality review consists of one or more of the following actions by the OQR reviewer:

    • a review of the RSDI claims material and other documents and records related to the case;

    • a contact (mail or telephone) with the beneficiary or representative payee; and

    • contacts with third party collateral sources of information.

  5. e. 

    OQR prepares reports for publication and develops corrective action recommendations based on the data. Recommendations may take the form of legislative proposals or suggestions for changes in Program Operations Manual System (POMS) policy or procedures.

2. Quality review and contact with the public

Below is a description of the RSDI quality review and contact with the public.

  1. a. 

    For some reviews, the quality reviewer sends the beneficiary or representative payee an appointment letter to explain the purpose of any required interview and schedules an appointment.

  2. b. 

    The appointment letter provides the quality reviewer’s name and the telephone number of the OQR Field Site so that the beneficiary or representative payee can call with questions about the quality review.

  3. c. 

    OQR uses mail and telephone to contact the beneficiary and third parties.

  4. d. 

    The beneficiary or representative payee may contact the field office (FO) or teleservice center (TSC) to verify the authenticity of the quality review or identity of the quality reviewer. When the FO or TSC receives an inquiry, they should access the OQR Staff Directory to verify the identity of the interviewer and provide the individual with information about the quality review.

3. OQR field site telephone contacts

Visit OQR Field Sites for a listing of contacts.


GN 04410 TN 9 - RSI Claims Quality Appraisal System - 3/12/2020