Purpose of QRT IQRs

6. QRT IQRs

Introduction

This topic contains information about QRT IQRs, including

• purpose of QRT IQRs
• review criteria for QRT IQRs
• standard of review for QRT IQRs
• recording method for QRT IQRs,
• QRTIQR-FINAL review level and QRT Coach responsibilities, and,
• QRTIQR-RETURN Review Level and Respnsibilities.

Change Date

August 20, 2026

6.6.a. Purpose of QRT IQRs

A review of the individual’s work is intended as a performance measure to ascertain the quality element in that individual’s performance standard.

A QRT IQR is intended to provide an evaluation of an individual QRS’s work product to determine if the minimal standard for correctness has been met.

QRT IQRs are the review of five (5) randomly selected cases per month (on average) for the QRS. This review determines the employee’s individual quality level under the applicable performance standard for the employee's position.

The intent of the performance standard is to obtain an average of five (5) per month over the entire fiscal year for each employee to assess the quality element in the standard.

6.6.b. Review Criteria for QRT IQRs

QRSs are responsible for performing IQRs identified by QMS on other QRSs. QRT IQRs with cited errors will be routed via QMS to a QRT Coach for a third review and determination as to if a performance error exists.

These reviews will consist of a random selection of work based on the amount set forth in the national performance standards. The selection of actions, while random, will reflect an appropriate mix of work performed by the employee throughout the month (i.e., not from a single day or single week). However, when a QRS is not working the appropriate mix of work on an ongoing basis to provide a mix of work for the QRS, the selected reviews are to be accepted.

QRT IQRs are only completed on the initial review of an IQR. If the QRS is not completing an adequate volume of initial IQRS in QMS due to local workload determinations, the QRS may not receive all of the intended reviews each month. QMS cannot retroactively pull reviews from a prior month.

6.6.c. Standard of Review for QRT IQRs

The standard of review for QRT IQRs is to ensure accurate completions of the quality checklist used for RVSR, VSR, MSC, and CA IQRs. The QRT IQR will encompass a thorough assessment of the QRS’s completed checklist in its entirety to ensure that the minimum standard for review has been met on the initial quality review.

The minimum standard includes proper selection of “Yes,” “No,” and “NA” on the checklist task questions.

• The minimum standard for review is to ensure all “No” responses on the checklist rise to the level of a clear and unmistakable error (CUE) or a clear violation of current regulations or directives.
• The minimum standard for review is to ensure all “Yes” responses on the checklist account for the proper actions implicitly or explicitly taken by the RVSR, VSR, MSC, or CA for the transaction(s) under review.
• The minimum standard for review is to ensure all “NA” responses on the checklist do not apply to the transaction(s) under review.
• S electing the proper checklist responses to reflect the appropriate answer for each task is important to ensure the RVSR, VSR, or CA receives credit for work completed correctly or ensuring the employee does not receive undue credit for work not applicable to the transaction under review.

A QRS performing a QRT IQR will select either “Agree” or “Disagree” with the initial review performed. If an error is found on the initial review, to include only changing a task question response from “Yes” to “NA” or “NA” to “Yes,” the reviewer performing the QRT IQR will identify the task question(s) in error in the comment box along with a complete error narrative.

QRT Performance Errors are required when correcting question responses to reflect the appropriate answer for a task because it is important to ensure RVSRs and VSRs receive credit for work completed correctly or to ensure the employees do not receive undue credit for work not applicable to the transaction(s) under review.

When changing a response to a question, only changes to Questions 1 through 11 on the MSC, VSR, and RVSR checklists and the entirety of the MSC and CA checklist are considered critical. A change to a non-critical question is not considered a performance error against the QRS.

Important: A performance error is warranted any time the checklist is found to be in error for a critical question. Whether something rises to the level of a benefit entitlement error is irrelevant when conducting and completing IQRs.

Example: An RQRS is completing a review on the rating decision complete (RDC) transaction. The previous RQRS marked the review correct. The RQRS conducting the QRT IQR determined that the evaluation for sleep apnea was incorrect because the RVSR did not assign a 50 percent evaluation based upon use of a CPAP. The RQRS will “Disagree” with the initial review and will include the following narrative in the comment box: “Error for incorrect evaluation of sleep apnea. The RQRS failed to cite a Task 7 error on the RVSR.”

A coach reviewing this disagreement on a QRTIQRFinal review would indicate that a performance error is appropriate against the RQRS who completed the initial review.

Example: An AQRS is completing a review on the claim transaction for generating an award (Award). The previous AQRS marked a Task 9 error because the award did not include a withholding for military retired pay. The AQRS conducting the QRT IQR determined that a withholding was not required. The AQRS will “Disagree” with the initial review and will include the following narrative in the comment box: “No error is present. The AQRS incorrectly cited a Task 9 error on the VSR.”

A coach reviewing this disagreement on a QRTIQRFinal review would indicate that a performance error is appropriate against the AQRS who completed the initial review.

6.6.d. Recording Method for QRT IQRs

An IQR on a QRS is identified as “QRTIQR” in the “Review Level” column in the “My Reviews” view, which can be accessed by clicking on the “Reviews Landing Page” tab. Whether the IQR selected is for a QRS can also be identified by reviewing the “Review Detail” screen. If QMS selects an IQR for a QRS, the “QRT Performance Review” box is checked on the “Review Detail” screen.

To open the review, click on the review name in the “Review Name” column, which will open the “Review Detail” screen. To see additional information, select the “Review Summary” button from the “Review Detail” screen.

To begin the review:

• Select the “Perform Review” button on the “Review Detail” screen.
• Scroll down to “Claim Review – Initial Review Process” which will display the recorded review to include any errors cited and error citation box.
• After completing a review of the QRS’s review, scroll down to the “Subsequent Reviewer Decision” section, which includes “My Comments,” “Agree,” and “Disagree.”
• The reviewer will complete the “My Comments” box and select either the “Agree” or “Disagree” button depending on the outcome of the case. If “Disagree” is selected, the reviewer provides the error narrative with the task question(s) from the associated quality review checklist.

Note: A comment is required regardless of whether the “Agree” or “Disagree” option is selected.

I f the second reviewer agrees with the QRS’s initial review, the QRS will input a detailed comment outling what they are changing and why they disagree, select the “Agree” button, and click the “Submit” button. Once the QRS selects the “Submit” button, the review is complete.

If the reviewer disagrees with the QRS’s initial review, the checklist completed during the initial review will require modification and/or correction. When the “Disagree” option is selected, the reviewer is returned to the initial review page that contains the “Claim Information” with the error citations and comments provided by the initial reviewer. The QRT IQR reviewer will cite any additional errors found, correct any of the errors cited on the initial review, and/or correct any responses to the task question(s). After correcting the corresponding checklist, the reviewer selects the “Review Summary” button. The reviewer will also notate the error that was cited or that should have been cited from the applicable checklist, along with any changes to task question responses. Once the review checklist is updated and the error narrative is input in the comment box, the reviewer will select the “Submit Review” button and the review is complete.

Reference: Refer to the QMS User Guide for QRT IQR routing rules and procedures.

6.6.e. QRTIQR-FINAL Review Level and QRT Coach Responsibilities

QRT IQRs with cited errors will be routed via QMS to a QRT Coach for final review.

All QRT IQRs that result in a “Disagree” are routed to the QRTIQRFinal review level. This level is directed to a QRT Coach for a determination on the outcome of the review. The Coach performs the review using the same steps listed above.

Coaches are responsible for determining if there was a performance error shown in the initial review.

Important: If the Coach is agreeing with the changes to the review made by the last individual that reviewed the case, this indicates the QRTIQRFinal individual is approving the changes and the disagreement indicated by the QRTIQR reviewer. A disagreement at the QRTIQRFinal level is used if the Coach does not agree with the subsequent reviewer’s determination

6.6.f. QRTIQRRET Review Level and Responsibility

After a QRT coach completes the FINAL level review, the IQR is returned to QRS that completed the inital review. It is at this time that the QRS will be able to see in the review record if an error was cited against them by reviewing the field "QRT Performance Error." The previously reviewing coach is required to mark either "Yes" or "No" before returning the review to the inital reviewer.

After the intial reviewer has had an opportunity to review the error cited against them, the local QRT Coach is responsible for finalizing the review with the QRS. It is critical that this is completed in a timely fashion so that the employees selected for IQR receive timely feedback on their work.

An infographic of the IQR process, to include the QRTIQR procedures can be found online in the Quality Assurance section of the Compention and Knowledge Management website at this link. It is found under the folder ' Quality Assurance Guidance' and named 'IQR Flow.'