PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 044 – Quality AppraisalSubchapter 40 – Federal Quality Review of Disability DeterminationsTransmittal No. 110, 07/16/2020
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedures. This POMS is being revised to make minor grammar, punctuation, and technical corrections, to improve clarity, and to update obsolete POMS references throughout the section.
Summary of Changes
GN 04440.006 Quality Reviewer Responsibilities
2nd Bullet: We corrected the title of the POMS reference at the end of the bullet from ,"Processing Correct Disability Cases" to "Processing Correct or Corrected Disability Cases", because it was recently changed when the POMS was updated.
3rd Bullet: Changed POMS reference number from GN 04440.135 to GN 04440.130, as the Medical Review Process POMS is being updated.
Added a comma after the word "Explanations" in the first POMS reference title.
Changed the POMS reference at the end of the bullet from GN 04440.236, Notices Requiring a Technical Corrective Action, to GN 04440.232, Non-substantive Technical Corrective Actions (TCAs), as the POMS has been updated since this POMS was last published.
12th Bullet: Corrected the title of the POMS in the second sentence to accurately reflect the actual title.
13th Bullet: Added commas after the word "results" and after the word "system", to improve clarity.
Federal quality reviewers are responsible for performing quality reviews of Social Security Administration (SSA) disability determinations to ensure conformance to SSA policies and procedures. Quality reviewers’ responsibilities include, but are not limited to, the following:
Reviewing each disability determination selected for federal quality review in accordance with the quality review standard described in GN 04440.007A. For additional information, see GN 04440.002, Introduction to the Federal Quality Review Process.
Clearing cases that do not require corrective action to the field office and, when appropriate, releasing any notices. See GN 04440.150, Processing Correct or Corrected Disability Cases.
Reviewing adjudicating component medical staff assessments and, if necessary, requesting guidance from regional medical or psychological contractors (MC/PC). See GN
04440.130, The Medical Review Process.
Reviewing regional MC/PC forms and assessments and recontacting the MC/PC, as necessary, to ensure proper file documentation.
Reviewing or initiating corrective action on both disability determinations in a concurrent case, even though review data is only recorded for the sample case determination.
Reviewing all notices and taking, or requesting, corrective action as needed. See DI
26530.001-.005, Personalized Disability Explanations, and GN 04440.232, Non-substantive Technical Corrective Actions (TCAs).
Rendering the final probability of reversal determination. See GN 04440.110, Probability of Reversal in the Quality Review Process.
Adjudicating cases when SSA assumes jurisdiction and completing all related actions. See GN 04440.244, Assuming Jurisdiction.
Ensuring the accuracy of all quality review forms and review results recorded to the Office of Quality Review’s (OQR) case processing system.
Retaining adjudicating components' determination documents in the electronic folder and, when appropriate, annotating them "Do Not Process" or "Do Not Release."
Moving non-essential material to section C (green) of the electronic folder, prior to case closure, to ensure proper folder documentation. See DI 20503.001, Documenting the Disability Folder.
Identifying and reporting possible fraudulent activities. See GN 04440.009, Fraud or Similar Fault (FSF) Procedures for Quality Reviewers.
Accurately recording quality review results, in the OQR case processing system, to ensure complete and accurate reporting data.