Electronic Medical Records Will Reduce Time for a Decision

The Social Security Administration and the Department of Defense (DoD) are working together to improve access to disability benefits for the nation’s Wounded Warriors, service members, veterans, and their dependents. A new nationwide project enables Social Security disability case processing sites to receive military medical records from multiple DoD facilities with a single request to a centralized DoD site. As of April 30, 2012, this initiative is in its first phase of nationwide expansion.

“Receiving electronic medical records for our Wounded Warriors and other military personnel will significantly shorten the time it takes to make a disability decision,” said Michael J. Astrue, Commissioner of Social Security. “This new process will improve the speed, accuracy, and efficiency of the disability program.”

Originally a pilot, the program included five states (Colorado, North Carolina, Oregon, Virginia, and Washington) and more than 60 military treatment facilities. These states are now receiving electronic medical records within 72 hours, a remarkable improvement over the previous average response time of five weeks for paper records from individual military treatment facilities.

The new DoD-Social Security collaboration consolidates requests for medical records from Social Security to a single location that has access to DoD records in a central electronic repository.

The benefits of the new process include:

• faster delivery of DoD medical records to Social Security,
• a more efficient system to obtain records,
• a reduction in the time it takes to make a medical decision on a disability claim, and
• a reduction in the number of consultative examinations (medical exams requested by Social Security when additional tests or medical records are needed.)

This is the first step towards the long-term goal of a fully automated solution of improving medical information sharing using health information technology and the Nationwide Health Information Network Exchange.

More information on Social Security’s use of health IT is available at www.socialsecurity.gov/hit.

Applying for Social Security disability benefits just became a little easier.

When a person applies for Social Security disability benefits, the agency conducts a disability review to determine if the applicant is actually “disabled” as defined by federal law. As part of this review, the Social Security Administration (SSA) contacts the applicant’s doctors and other medical providers to discuss the applicant’s medical history and to obtain important medical records that can be used throughout the disability determination process.

Since doctors and hospitals are not allowed to disclose a patient’s medical information to anyone, even the government, without the patient’s permission, the SSA requires all disability applicants to fill out a medical release form, commonly known as an SSA-827, which authorizes the SSA to obtain the required medical information from a medical provider and releases the provider from liability related to the release. Up till now, the SSA has required applicants to print out the form and either mail it into the SSA or bring it into a local office.

Because this procedure often delays the disability application process (the SSA cannot process the application without the signed release in hand), the government has decided to allow applicants for disability benefits to electronically sign the SSA-827 online as an alternative to filing a paper copy. Starting in April, adults with disabilities who are capable of signing their own medical release forms will be able to simply click and sign the SSA-827 as part of the application process. The SSA hopes to expand the electronic signature program to other categories of applicants, like children and people who are operating under a Durable Power of Attorney, in the future. According to the SSA, the new electronic signature option will reduce application processing time by an average of nine days.

To read about the changes on the SSA’s Web site visit www.ssa.gov.

Blog post by Sheri R. Abrams, Attorney at Law
Needham Mitnick & Pollack, plc
www.nmpattorneys.com
www.sheriabrams.com

Determining whether drug or alcohol abuse will affect a claimant’s eligibility for Social Security Disability benefits depends on materiality. If drug or alcohol abuse is found to be material to your disability you will not be able to win a case for Social Security Disability benefits. For example, if you were to apply for Social Security Disability benefits based on liver dysfunction and hepatitis, but you also have a history of alcohol abuse, some of it recent. If your liver damage is so pronounced that ceasing alcohol use completely would make no difference to your medical condition, then your alcohol abuse would be immaterial to your condition and you would probably win your case for Social Security Disability benefits. Conversely, if ceasing alcohol use would result in medical improvement, then it is material to your disability and your claim for Social Security Disability would likely be denied. Simply put, Social Security will not pay Social Security Disability benefits to claimants whose disabling conditions are exacerbated by drug and alcohol abuse.

Claimants who have a history of drug or alcohol abuse but are currently not using these substances should carefully review their medical records. Doctors will often indicate “possible use” in their treatment notes. Such indications, proven or not, can have a damaging effect on your Social Security Disability case. Claimants who suffer from a mental disability should especially be careful, as mental disability cases are more likely to be denied when substance abuse is involved.

While each case is unique, it is true an applicant has a better chance of obtaining Social Security Disability benefits if they are sober and remain sober.

Michael J. Astrue, Commissioner of Social Security, announced on February 1, 2010 that 15 healthcare providers and networks have received $17.4 million in contract awards to provide electronic medical records to the Social Security Administration (SSA). These electronic medical records, which will be sent through the Nationwide Health Information Network (NHIN), will hopefully shorten the time it takes Social Security to make a disability decision and will improve the speed, accuracy, and efficiency of the disability program.

“Using health information technology will improve our disability programs and provide better service to the public,” Commissioner Astrue said. “We’ve seen a significant increase in disability applications. To process them, the agency sends more than 15 million requests annually for medical records to healthcare providers. This largely paper-bound workload is generally the most time-consuming part of the disability decision process. The use of health IT will dramatically improve the speed, accuracy, and efficiency of this process, reducing the cost of making a disability decision for both the medical community and the American taxpayer.”

The contract awards are funded through the American Recovery and Reinvestment Act (Stimulus). They will require awardees, with a patient’s authorization, to send Social Security electronic medical records through the NHIN. The NHIN, a safe and secure method for receiving access to electronic medical records over the Internet, is an initiative of the Department of Health and Human Services supported by multiple government agencies and private sector entities.

For the last year, Social Security has been successfully testing health IT to obtain electronic medical records. Disability applications processed with electronic medical records from the test sites have significantly reduced processing times. Some decisions are now made in days, instead of weeks or months. Social Security expects to receive more than 3.3 million applications in fiscal year (FY) 2010, a 27 percent increase over FY 2008.

Hospitals often give patients a health care power of attorney (health care proxy) form to sign on being admitted.   While signing a generic health care power of attorney form is better than not signing one at all, these documents vary in the amount of care that has gone into their drafting, and having one that is specifically tailored to your needs can be important. 

A health care power of attorney allows you to appoint someone else to act as your agent for medical decisions. In general, a health care power of attorney takes effect only when you require medical treatment and a physician determines that you are unable to communicate your wishes concerning what that treatment should be.   Appointing someone to serve as your agent helps ensure that your medical treatment instructions will be carried out.

While a health care power of attorney serves to appoint an agent to speak for you, you can also use it to give the agent guidance about your medical wishes.  Following are some issues that can be addressed in a health care proxy:

•The name of the person authorized to act for you. It is good to appoint an alternate as well.
•Whether or not you want to be kept alive by machines if you are in a persistent vegetative state.
•Under what circumstances you want pain medication to be administered.

Whatever choices you make, you should take time to consider your health care wishes before signing a health care power of attorney.  For this reason, signing a generic hospital form may not a good idea, as many of these forms will not take your individual wishes into account.

Also bear in mind that if you already have a health care power of attorney as a part of your estate plan, the generic form will revoke your more personal health care power of attorney.

A qualified attorney, such as Sheri Abrams, can help you create a health care power of attorney that addresses your particular situation. You can then take this document with you to the hospital and have it made part of your medical records.

Individuals with various health conditions are often reluctant to leave jobs because they are afraid pre-existing condition clauses will limit coverage of any such conditions under a new insurance plan. HIPAA (Health Insurance Portability and Accountability Act of 1996) limits the amount of time an insurer can refuse to cover pre-existing conditions to twelve months. HIPAA also ensures that in some cases there is no waiting period for new coverage. However, an insurer is still not required to cover every condition and disability. In some cases, they can still deny coverage altogether for certain conditions as long as the decision is based on sound actuarial data.State laws may offer more generous protections than HIPAA. You may want to contact your state insurance commissioner’s office to ask about the law where you live. A good place to start is the Web site of the National Association of Insurance Commissioners at www.naic.org.

A “pre-existing condition” is considered to be any condition for which medical advice, diagnosis, care or treatment was recommended or received within the previous six-month period. The maximum amount of time a plan can refuse coverage for any such condition is twelve months. If an individual starts a new job and is subject to a waiting period before being eligible to join the health plan, the waiting period and twelve-month period for the pre-existing conditions must coincide.

The twelve-month period for pre-existing conditions may also be reduced if the individual provides the new insurance plan with proof of their prior health coverage. When leaving a health plan, the plan must provide you with a Certificate of Coverage which details the dates you were covered under the plan. This continuous coverage can be credited toward the pre-existing condition period, provided there was not a “significant break” in coverage between jobs – this is defined as sixty-three days.

Therefore, if you had at least twelve months of “creditable coverage” (which can be from a group health plan, HMO, individual health insurance policy, Medicare, or Medicaid) and then left your job and you started a new job within sixty-three days thereafter, the pre-existing condition period would not apply. Your condition would be covered immediately (provided that the plan regularly covers that condition). COBRA coverage can also be credited towards continuous coverage.

HIPPA can also help provide access to individual insurance when group coverage is not an option. HIPAA guarantees access to an individual plan if: the individual had group coverage for at least eighteen months; did not have their group coverage terminated because of fraud or nonpayment of premiums; is ineligible for COBRA or has exhausted COBRA benefits; and is not eligible for coverage under another group health plan.