Outcome of National Reviews

5. Reporting the Correction of National Error Citations

Introduction

This topic describes procedures for reporting the correction of national error citations, including

• outcome of national reviews
• clearing PMC vs. correcting PMC
• action to take following notification of a national error
• EP 930 establishment requirements
• corrective actions and reporting
• time limit for corrective actions
• indicating when re-adjudication is not appropriate, and
• responsibility for corrective action by the
• clearing PMC's QRT coach
• correcting PMC's QRT coach
• responsible employee, and
• responsible employee’s coach.

Change Date

October 15, 2021

7.5.a. Outcome of National Reviews

PMCs will learn the outcome of a STAR assessment that results in an error via the QMS.

In QMS, the created date shown on the correction record is the date the RO was notified of the error in QMS.

7.5.b. Clearing PMC vs. Correcting PMC

The clearing PMC is the PMC that cleared the EP identified for national quality review.

The correcting PMC

Note: Generally, the clearing and correcting PMC will match for most corrective actions.

• is the PMC that P&F Service has identified as responsible for taking the corrective action(s) documented during the course of a national quality review including those errors caused by a different PMC, and
• will be identified by its RO number at the beginning of each error narrative.

7.5.c. Action to Take Following Notification of a National Error

QMS will route the error correction record(s) to the clearing PMC in all cases. The national error correction record(s) will populate in the clearing PMCs Quality Review Team (QRT) coach's team queue.

The clearing PMCs QRT coach, or designee, will review the national error cited to determine if a reconsideration request will be submitted.

Use the table below to determine what actions to take when a reconsideration request is received.

Scroll sideways to see the full table.

7.5.d. EP 930 Establishment Requirements

An EP 930 must be established and cleared for any claim with a cited error where the EP has been cleared or cancelled, even those that do not require a rating or award correction. This requirement has been put in place to ensure data integrity. P&F Service will also monitor completion of error corrections using these EPs.

EP 930s must use the PMC – Correction of National Quality Error claim label and the National Quality Review special issue indicator.

Notes:

• The National Quality Review special issue indicator is a Do Not Recall (DNR) indicator that prevents the National Work Queue (NWQ) recall until the special issue is removed in conjunction with an appropriate transaction.
• If the EP associated with the claim reviewed for quality is still pending, which is likely following a local quality review, then an EP 930 is not necessary. Corrective action to include mentoring and entering a Veterans Benefits Management System (VBMS) note should be conducted under the existing EP.

References: For more information on

• the requirement to enter a VBMS note, see M21-4, Appendix B, and
• how to enter a VBMS note, see M21-1, Part II, Subpart ii, 2.A.1.c.

7.5.e. Corrective Actions and Reporting

The identified correcting PMC must take corrective action on all national errors.

All actions to initiate the correction must be done within 30 days of notification of the error. If multiple errors are cited on a case, all actions to initiate the correction of all errors must be executed.

When corrective actions are initiated, the error correction is considered complete for reporting purposes. P&F Service may review claims for accuracy after the record shows complete. If P&F service determines the PMC action did not correct the error, the claim will be returned to the PMC for additional corrective action.

If the corrective action needed is development, rating correction, or award promulgation, once executed, the ERROR CORRECTED box in QMS must be checked and the DNR special issue indicator removed.

If no further action is needed after the corrective action is taken and reviewed by a supervisor for completion, the EP 930 should be cleared.

If the only corrective action is to provide training and/or feedback to the responsible employee, once a supervisor has confirmed the training and/or feedback has occurred, a VBMS note should be entered and the EP 930 should then be cleared.

7.5.f. Time Limit for Corrective Actions

The correcting PMC is required to initiate and report the corrective action taken for each error within 30 days of the error notification.

7.5.g. Indicating When Re-Adjudication Is Not Appropriate

In cases where re-adjudication may be inappropriate, the correcting PMC must indicate why re-adjudication is not appropriate and describe the other action taken, such as training or feedback provided to the responsible employee when updating the error correction record in QMS. The clearing PMC may also indicate that reconsideration has been requested. If the reconsideration request is denied, the corrective action must be taken and appropriately reported.

7.5.h. Responsibility for Corrective Action by the Clearing PMC’s QRT Coach

When upon review by the clearing PMC's QRT coach, or designee, it is determined that a reconsideration request is not warranted, the reviewer must identify the PMC responsible for corrective actions using the RO number annotated at the beginning of the error narrative(s).

When the identified correcting PMC is also the clearing PMC, the clearing PMC will maintain ownership of the correction record(s) and must take corrective actions.

When the identified correcting PMC is a PMC other than the clearing PMC, the clearing PMC's QRT coach must transfer the error correction record(s) to the correcting PMC's QRT coach team by selecting the CHANGE OWNER box for each error correction record that needs to be transferred.

The error will remain in pending notification status, and this action also confirms that the error has been reviewed and accepted by the clearing PMC.

7.5.i. Responsibility for Corrective Action by the Correcting PMC's QRT Coach

Follow the steps in the table below for corrective actions of the correcting PMC’s QRT coach.

Scroll sideways to see the full table.

7.5.j. Responsibility for Corrective Action by the Responsible Employee

Follow the steps in the table below for corrective actions of the responsible employee.

Scroll sideways to see the full table.

7.5.k. Responsibility for Corrective Action by the Responsible Employee’s Coach

Follow the steps in the table below for corrective actions of the responsible employee’s coach.

Scroll sideways to see the full table.