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Find answers to frequently asked questions.

Question:
My agency received a bill for medical records. What should we do if we do not have funding available to pay the bill?

Most states have laws that regulate what health care providers can charge individuals for copies of their medical records. However, these rules do not necessarily apply to providers requesting records. In addition, some states provide an exception for records needed to apply for a disability benefits program and stipulate that they be provided at no-cost. For more information on state statutes and regulations regarding the collection of fees for medical records, click here.

If your state does not require a fee-waiver, we recommend contacting the director of the medical records department and advocating for or negotiating one. Explain that the individual is homeless and that you, as a mutual provider, are unable to pay for the records. Let the director know that the records will be used for a disability application and that, upon approval, the individual will likely be eligible for Medicaid and/or Medicare benefits that will pay for uncompensated care that the provider has given as well as future care that is provided. Therefore, it is in the provider’s best interest for the individual’s application to be well supported and documented as an approval may lead to retroactive and future reimbursements.

In addition, offer to the director of the medical records department that you would be happy to write a letter to the administrator of his/her agency regarding how helpful the director has been as well as the potential financial recoupment that such collaboration will mean to the provider.

If they are unwilling to waive the fees, try contacting United Way or other community action agencies that may be able to pay all or part of the bill.

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Question:
Are there trainings available for physicians to help improve medical record documentation?

The Documenting Disabilities training from the National Health Care for the Homeless Council is a great way to train doctors in the community on creating medical records and documentation that can help assist with SSI/SSDI applications. It clarifies the myths and helps develop a better understanding and support of what SOAR case managers are doing. The online curriculum is approximately 3-4 hours and has 2 basic parts: An introduction to the SSA disability determination process and then explanations and examples of how to document a person's physical (less emphasis on mental illness) impairments in a letter to be submitted to SSA. It is a great draw for physicians because NHCHC offers free CMEs. The training is now offered online at no-cost. The link to their website: http://www.nhchc.org/training-technical-assistance/online-courses/dd-101/.  You can download and read the manual and/or watch the online videos for the course.

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Question:
What are your recommendations if the client does not have enough medical documentation to support their illness ?

To meet SSA’s definition of disability, the applicant’s diagnosis must be documented in medical records, laboratory reports, or other clinical findings of a physician or psychologist. DDS prefers that medical evidence come from an ongoing treatment provider. If this medical documentation is not available because the applicant has not received treatment for these conditions, we recommend that SOAR practitioners try to arrange for a physician or psychologist to conduct assessments, including documenting the applicant’s diagnosis and functioning, before submitting the SSI/SSDI application.

If it is not possible to arrange an evaluation before submitting the application, DDS may arrange for a consultative exam (CE) for the applicant, including physical or psychiatric testing based on the applicant’s alleged conditions. More information about CEs can be found here. In these instances, it is especially important that the SOAR practitioner provides comprehensive information about the applicant’s impairments in functioning through the Medical Summary Report. Collateral information from caseworkers, family members, and former employers can also be helpful in supporting an application with limited medical documentation.

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Question:
I already have medical records from another provider in my chart/file. Can I send those to SSA now that I am helping this individual apply for SSI/SSDI benefits?

Most states prohibit the re-release or “further release” of records once they have been released to an entity that originally requested them. However, if you send a request for records using the SOAR Process, which includes (1) a signed SSA-827 Authorization to Disclose Information and (2) a signed Agency Authorization to Release Information (either using the sample on the SOAR Tools & Worksheets page or your agency’s HIPAA compliant release), you will be able to send those records on to SSA.

Also included on the SOAR Tools & Worksheets page is a Medical Records Request Letter, which explains the purpose of the records request. This process of sending two releases is permitted under the HIPAA Privacy Rule as a “compound authorization.” The regulation can be found in the Code of Federal Regulations: Title 45 Part 164 Section 164.508. Source: Code of Federal Regulations: Title 45

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Question:
I received a notice with a patient’s alcohol and drug abuse records that I could not “further disclose” the information. How can I send them on to SSA?

When providers of substance use services (drug and alcohol) release records, they are required to include the following notice from the CFR Title 42:2.32:

“This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.” Source: http://edocket.access.gpo.gov/cfr_2002/octqtr/42cfr2.32.htm

However, the law allows the records to be disclosed to any entity the person names in the consent. When you complete the SSA-827: Authorization to Disclose Information to SSA be sure that it specifically mentions the release of drug and alcohol treatment records.

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Question:
I requested records from a provider using a faxed copy of both the SSA-827 and my agency’s release. This provider will not release them without an original signature on the authorization form and I only have a copy. What do I do?

You should be able to use the copy of the authorization that you have to request the records. According to a clarification letter drafted by the Director of the Office of Civil Rights on April 25, 2003, “A copy, facsimile, or electronically transmitted version of a signed authorization is also a valid authorization under the Privacy Rule.”
Source: https://www.socialsecurity.gov/disability/professionals/documents/HHS-OCRfeedback.pdf

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Question:
Am I allowed to disclose mental health treatment and counseling records to SSA?

Mental health treatment records are a necessary and integral part of the evidence needed for DDS to make a disability determination for someone alleging mental illness as an impairment. You are permitted and encouraged to support a claimant’s application with the disclosure of your records (with proper authorization). The records that are excluded from this authorization are “psychotherapy notes,” which are a specific type of note not typically a part of most medical records, especially in publicly funded settings.

As HIPAA defines the term, “psychotherapy notes means notes recorded in any medium by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record. Excluded from “psychotherapy notes” are medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

If you keep psychotherapy notes separate from your other medical records, you can send the set of records without the psychotherapy notes. If you do not keep psychotherapy notes separate from other parts of the medical records, you can legally disclose all of the records. However, you can choose to black out or remove the parts of the records that would be considered psychotherapy notes. Another option is to prepare a report that details the critical current and historical aspects of the applicant’s treatment and functional information, such as a SOAR Medical Summary Report.

For more information, see SSA’s Fact Sheet for Mental Health Care Professionals.

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Question:
As the appointed representative, if I am not able to pay for copies of the medical records, can I get them from SSA or DDS?

As the claimant’s representative (using the SSA-1696 Appointment of Representative Form), you can request a copy of the claimant’s previous and current files, which include the medical records SSA and DDS received with the application. These documents are generally provided on a CD. This is allowed under the Privacy Act (5 USC § 552a (b)) “An individual may give SSA written consent to disclose his/her personal information to a third party of his/her choosing.”

Note: When using the SOAR process, staff will want to collect the medical records and submit them to DDS rather than the other way around. The reason for this is to ensure that the DDS receives all pertinent information. However, obtaining a CD from DDS can be useful when you assist an individual who has already applied and been denied.
Source: https://secure.ssa.gov/poms.NSF/lnx/0203305001

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Question:
Some of the records I received from medical facilities are on a disc, how do you recommend submitting these to DDS? I have printed limited pages for MSR writing, but not the disc in completion.

This is a great question! While DDS does not have a way to process records received via disk, this sounds like a good opportunity to speak with them about signing up for Electronic Records Express, which allows you to upload medical records directly into an applicant’s file from your computer without having to print them. I recommend reaching out to your DDS Professional Relations Officer, or your local SOAR contact, for details on how to register.  This should be a quick process, allowing you to upload these records without delaying your current case.

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Question:
My client has not been completely honest with hospital staff because he "does not trust people." Therefore, his medical records do not show all of his illnesses. Should I send all of the records I have, or just the parts that actually show his illnesses?

You should definitely send all of the medical records. SSA has a rule called the “All Evidence Rule” which requires applicants (through their representative) to submit all medical information known, which includes knowledge of impairment and/or treatment sources. 

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