GPS
If a medical record has 60 pages or more is it a pass or fail ?
Pass - As long as the length is there we can pass the medical records , it is not our job to go through the medical records and see if the conditions that are listed in the GP are in the medical records. That is the med rec teams job.
If there is something wrong or incorrect with a DBQ ( even if it's just a minor spelling error ) , What do you need to do ?
Notate it in the Rater Error Thread and send out the correction that needs to be made to the the support and rater thread to have the rater fix the mistake
What is a P&T ?
veterans whose disabilities are total (i.e. rated 100% disabling by VA) and permanent (i.e. meaning they have a minimal chance or no chance of their condition ever improving).
Name What needs to be done If a FQC fails
- VA the files that were gtg (If there was any ) and upload only those that are VA'd to the CRM ( MAKE SURE THEY ARE SIGNED )
- Action it general comment if sending to Gracie , if you are asked to send it to tpsych please action it doctor fail or rater failed which ever applies , these fails are usually technical erros
- Put up ticket for corrections with the following listed , Doctor , name of the DBQs and all the corrections that need to be looked at , link ,state, and whether its REE or TPsych
_ move folder to pending corrections
List the General things you look for when doing a GP
CSA , MPOU , ROI , DC , SS, RDL , Medrecs , lead details , last check if the GP meets criteria
Name at least 4 conditions that REQUIRE medication listed even if it's over the counter to pass GP
- Headache
- GERD
- Sinisitus / Rhinitis
- Diabetes
- Hypertension
What do we do with files that have an ITF expiring during NS ?
We send it straight to tpsych no matter if it's a lengthy drive. REE will charge us an expedited fee , this fee will need to be paid before even being able to change the status. We want to avoid sending to REE if the ITF is expiring unless affiliate has agreed with the expedited fee REE charges us and fee has been paid. REE charges 500 dollars for any file with an ITF expiring of 10days or less and a 300 dollar fee for anything that is 11-90 days
When you receive a phone call/ voicemail / or text mssg from a vet saying they received an increase. What three places does it need it to be in in order for you to be able to claim it in your invoice.
- CRM in a comment
- Affiliate thread
- File At VA calls thread
Do the changes of the ROM matter ?
Yes , the flareups can affect the veterans rating if they are adjusted
Can you increase a skin and a scar condition in the same location at the same time ?
No , You will only get the higher rating of whatever they granted , whether it be from the skin condition or the scars but not for both
In order to meet the 30% criteria for Rhinitis what do they need ?
- Pylops and medication listed
What thread do we not send any updates for NS ?
Veteran comp -
What are we not allowed to do when failing a GP ?
Give advice to the affiliate of what they should do to fix the GP.
We only need to list the things that are wrong and move on , if they need to know what they need to meet a certain criteria they need to get with their lead themselves or they can contact a rater if they'd like to help them out.
Does it matter if the doctor adds or takes away an assistive device ?
Yes ! Only in certain DBQs , please ask your lead if unsure! Usually the ones that need to be reviewed by Gracie are those assistive devices that are removed and are needed to meet a certain criteria for example , the knee DBQ , if they are shooting for instability 20 and the doctor removes the assistive device it will affect the rating. Just to be on the safe side if the assistive device was removed for a knee , hernia , foot DBQ - send to Gracie , all other ask your lead to double check if its okay
What is needed to meet criteria for 30% for GERD ?
- Persistent epigastric distress -dysphagia -pyrosis/ heartburn - substernal/arm pain - Regurgitation
What 2 knee diagnosis/conditions cannot get instability unless there is also an injury to the ligament ?
patellorformal pain syndrome and chonromalacia
Make sure that all clinics are ..
Walk-ins, we no longer allow Telehealth appointments , all appointments need to be in person.
What are the five next steps in our file flow that come right after " Mini Review "
1. GP VAlidation 2.Generate DBQs 3. Network Selection
4. Med Rec Review 5. final Quality Control
What do all DBQs need checked yes on ?
Seen in person as yes and medical records need to be checked and listed as well
When dealing with a lung condition what do we usually need uploaded along with the PAQ ?
A PFT - ( Pulmonary function test )
When increasing a scar condition ( Affiliate will list it in the GP if they are ) What things need to be present in order to pass ? ( In the PAQ and in the CRM )
- Scare size , location , # of scars listed
- Description / History of the scars / How it affects them / If they are painful / Texture
- If scars were obtained through surgery please have them name the surgery and provide the month and year the surgery was done in
- We need pictures uploaded to the CRM
What Do you action the status when you have to select to both REE and Tpsych? What does the verbiage need to look like ?
If selecting to both networks , Status it " Use tpsych " the affiliate will then upload whatever needs to be uploaded to REE to REE and whatever needs to go to tpsych will be sent to tpsych. the verbiage would need to look something like this.. DBQs complete sending MEDICAL to Tpsych and MENTAL to REE. Please review all DBQs and upload when ready. Thank you. ( Closest MENTAL clinic is approximately *** Hours **minutes away , in ****,**, Walk-in /Closest MEDICAL clinic is approximately *** Hours **minutes away , in ****,**, Walk-in )
What is the first thing to check when you're doing GPs, NS , and FQC ?
THE ITF , we have many that have been missed , please make sure you guys check the ITF before anything else on the file
What thing is crucial to make sure is always checked yes in the Mental DBQ ?
If the veteran can handle his finances on his own
What do we look for in a PFT ?
We look for the % predicted before meds that tells us their lung capacity