PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 044 – Quality AppraisalSubchapter 40 – Federal Quality Review of Disability DeterminationsTransmittal No. 117, 07/24/2020
The Office of Quality Review (OQR) is making editorial changes and completing updates throughout the quality review sections of the POMS to improve readability, add clarity, and ensure conformance with Plain Language Guidelines.
Summary of Changes
GN 04440.006 Quality Reviewer Responsibilities
In the first bullet, we are changing the reference from GN 04440.007A to GN 04440.003G due to revisions in GN 04440.007.
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
04440.003G. 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.