Identification Number:
GN 04410 TN 11
Intended Audience:See Transmittal Sheet
Originating Office:OQR
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. 11, 11/18/2020

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

10/06/2020

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

 

Changed the reference of Office of Anti-Fraud Programs to Office of Program Integrity and updated the hyperlink.

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 (QR) 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 QR or identity of the OQR employee. When the TSC receives an inquiry, follow the instructions in TC 00101.035. When the FO receives an inquiry, the FO should follow the steps below to verify the identity of the interviewer and provide the individual with further assistance or information regarding the QR:

  • Open Outlook Exchange System and access the address book, known as the “Global Address List” (GAL). Use the GAL in Outlook to confirm that the reviewer is an employee of OQR.

  • Did you verify the employee’s name?

    • If yes, advise the caller that the individual is an OQR employee who is responsible for contacting beneficiaries. Assure the caller that OQR does request documents and or forms by mail for reviews.

    • If no, treat this as a suspicious contact and prepare a report via the Allegation Referral Intake System (ARIS). Users may access ARIS from SSA's IMAIN page, select the ARIS - Allegation Referral Intake System link. The link to ARIS is also on the Fraud Security and PII and the Office of Program Integrity homepages.

3. OQR field site contact information

You can find contact information for OQR field sites at this link: OQR Field Sites.


GN 04410 TN 11 - RSI Claims Quality Appraisal System - 10/06/2020