Social Security and Health IT

Disability claims are driven by medical records. Unfortunately, the process of requesting and obtaining medical records is the most frequent source of delay in the disability determination process. SSA requests over 15 million copies of medical records from over 500,000 providers each year to determine over three million disability claims. Because this is such a huge undertaking, not to mention a lot of paper, SSA has developed Health IT (HIT).

Established in 2008, HIT is a program that partners SSA with medical providers in order for SSA to gain easier access to the medical records via electronic methods. By electronically requesting and receiving records, the delay to receive the records goes from weeks or months to mere minutes or a few days.  The goal is to reduce the burden of copying and mailing records on healthcare providers, as well as offer applicants faster and more consistent disability decisions.

So how does it work? First, a health care provider must determine whether they qualify to participate in HIT. They must already be equipped to share electronic medical records, as well as possess the budget and resource allocation necessary for HIT. If the provider can fulfill these criteria, SSA asks that the provider:

1.       Accept patient authorizations to release medical information, and

2.       Provide the following medical information:

a.       Health problems and medication lists;

b.      Patient encounter information;

c.       Admission summaries and other medical notes;

d.      Procedures information and interpretation; and

e.      Information regarding treatments.

Currently, providers located in California, Idaho, Indiana, Massachusetts, Michigan, Minnesota, New Mexico, Oregon, Ohio, Texas, Virginia, Washington and Wisconsin are participating in HIT. Kaiser Permanente is the latest big name to partner with SSA on HIT, just recently in June, 2012. For a complete list of current participants, please visit http://www.socialsecurity.gov/hit/partners.html.

What benefits do HIT participants gain? Because the cost of copying and mailing medical records can be monstrous and time-consuming, HIT participants enjoy reduced administrative and supply costs (paper, toner, postage, etc).

Faster disability determinations also mean less uncompensated care for HIT participants. When a disability claim is approved in a timely manner, the claimant has more timely access to Medicaid or Medicare, as well. In 32 states, including the District of Columbia, when a claimant applies for SSI, they are also automatically applied for Medicaid. An awarded claimant must be eligible for SSI cash benefit for at least one month before becoming eligible for the Medicaid benefits, and must also receive at least $1 in benefits. On the other hand, the wait for Medicare benefits is 24 months after a SSD claim is awarded, so time is truly of the essence.

HIT participants may also enjoy higher revenue by having the ability to respond to a higher number of SSA requests in a timely fashion. SSA also pays HIT participants electronically and automatically for the medical records.

Disability claimants can also potentially benefit from HIT. Thanks to the reduced wait time for SSA to obtain a claimant’s records, a well-informed decision can be made in a more timely fashion, as long as the proper records pertaining to the claimant’s disability are received.

By obtaining a claimant’s full medical record from all treating providers, it becomes less necessary to send claimants to consultative exams funded by SSA. This is a plus for claimants who often have transportation issues as far as getting to the exams.

Unless the claimant has a representative, it is up to him or her to help SSA get all the records they need to make a decision. Usually medical providers charge a fee for the copying of the records, and the already hard-up claimant has a difficult time paying twenty dollars for records that may or may not be of use to their claim. In the state of Ohio, representatives have access to one free copy of medical records from treating providers, and have the ability to make sure SSA sees the right information that pertains to the claimant’s disabilities and specific time frame of disability. With more and more providers enrolling in HIT and making their records available, hopefully it will become less of a concern for claimants who do not have representation and rely on their treating providers to make the pertinent information available to SSA.

In 2011, the number of providers participating in HIT doubled. SSA hopes to keep up this trend for the greater good of claimants and their doctors alike. However, this is not a guarantee of a positive outcome for a claim. It is always advisable to hire a professional representative to make sure all of the information pertinent to a disability claim is seen by SSA. (Please read our previous blog entry, Obtaining Representation and How it Affects Your Claim, to read about what else representation can do for you)

Source: http://www.socialsecurity.gov/hit/index.html

Written by Anna Westfall and edited by Paulette Balin

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