Management stated that a percentage is
reached based on a combined data base of both High Risk and Central Quality
Assurance (CQA) reviews. High Risk reviews may vary by PC based on Operational
need.
Employees accuracy in all case types should reasonably approximate the
average PC accuracy for that period.
Issue 2: Performance standards indicate that 120 cases will be reviewed
yearly for each DA2.
The Workgroup agreed that 75-80 cases would be a reasonable number of
cases to be reviewed per year to produce a reasonable picture of the analyst’s
quality.
Issue 3: Rebuttals
It was agreed that office policy is that an accepted rebuttal equals a
correct case.
PEF asks that this process be verified in each PC and corrected if necessary.
This has been achieved.
Issue 4: Language in Performance Evaluation Standards:
The Workgroup recommends that:
1) Current language in the standards be updated by revising the reference for
substantive deficiencies from "Spar Categories" to "Group 1
Deficiencies" so that the reference is consistent with the POMS citation.
Accuracy for each DA2 be based on a reasonable approximation of the PC
average for that period.
Issue 5: Responsibility
The Workgroup agrees that responsibility for the accuracy of a case rests with
the decision maker. PEF asks that both CQA and each PC verify that an override
is utilized when charging returns for cases that have been determined by someone
other than the assigned analyst. This may require a system adjustment in CQA.
The Medical Review Standards will be the next project for this committee.
NOTE: The
