GN 04440.008 Quality Review Process
In Section A., we:
Replaced the hyperlink in the second sentence with "section B below", as it was not necessary.
In Section B., we:
Added "Quality reviewers" to the first sentence to make it clear who the instructions pertain to.
In Section B.1., we:
Added the title of the POMS (Quality Review Exclusions) to the first sentence.
Added a comma after the word "exclusion" in the first and second sentence.
In Section B.2., we:
Removed the parentheses from the second sentence.
In Section B.3., we:
Removed the acronym "SSRs" from the first sentence, as that term was only used once in this POMS and the acronym is unnecessary.
Added a comma after "suspected" in the fourth sentence.
Moved the word "step" in the fourth sentence to the beginning of the fifth sentence.
Removed the word "Form" from the first bullet, as it was unnecessary.
In Section B.4., we:
Removed "on Form 448 (Request for Medical Advice)" from the second sentence and replaced it with "using the medical referral in the case processing system" to reflect the Office of Quality Review's (OQR) updated language and terminology.
Changed "MC/PC" to "MC or PC" in the third sentence.
Changed " MC/PC" to "an MC or PC" in the fourth sentence.
Also added "assessing the accuracy of the" prior to the word "symptom" in the fourth sentence to help clarify the meaning of the sentence.
Made a complete sentence for the POMS reference found at the end of the fifth sentence (in parentheses).
In Section B.4.--NOTE, we:
Changed "MC/PC" to "MC or PC" in first sentence.
Removed "OQR determination" and replaced it with "conclusion(s)" as this more accurately reflects the usual duties of a quality reviewer.
In Section B.5.a.1., a.2., and a.3.,
Updated the POMS references, as they have changed since this POMS was last published, and included the titles.
In Section B.5.b.2., we:
Added "or cessation" to the end of the first sentence.
Reworded the last sentence to read, "Reviewers must provide a rationale whenever POR is considered or applied.", as this improved the clarity of the sentence.
In Section B.6., we:
Added commas after "request" and "take" in the first sentence.
Added the title of the POMS after "GN 04440.202".
In Section B.7., we:
Added "/or" after the word "and" in the third sentence.
In Section B.7.a. and 7.c. we:
Added "cases with" prior to group I and group II deficiencies and TCAs, to give the sentences an accurate subject.
In Section B.8., we:
Added "/or" before "and" in two places in this section, as the sentences are not accurate without this addition.
Replaced "it" with "the case", added "the quality reviewer should" prior to "reevaluate", and removed the hyphen from re-evaluate", in the first sentence, to improve comprehension.
Changed "second" to "subsequent" prior to the word "return" in the third sentence, as this reflects OQR's updated terminology.
Updated the POMS reference in the third sentence to an OQR (GN) specific POMS, rather than one typically used by adjudicators.