strengthening applications: collecting medical evidence presented by: national soar technical...
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Strengthening Applications: Collecting Medical Evidence
Presented by:
National SOAR Technical Assistance CenterPolicy Research Associates, Inc.
Under contract to:
Substance Abuse and Mental Health Services AdministrationU.S. Department of Health and Human Services
Welcome
Pamela J. Fischer, Ph.D.Social Science Analyst
Homeless Programs Branch
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
Webinar Instructions
Question instructions
Muting
Recording availability
Agenda
Strategies for Collecting Medical Evidence
Kristin Lupfer and Will Connelly, SOAR Technical Assistance Center
Collaborating with Local Hospitals
Tarry Truitt, Mercer Alliance to End Homelessness, Lawrenceville, NJ
Social Security’s Electronic Records Express
David Vinokurov, Social Security Administration, Trenton, NJ
Collaborating for No-Cost Records
Patrick Halsmer, New Mexico Human Services Department
Lisa Huval, New Mexico Coalition to End Homelessness
Albuquerque, NM
Internal Collaborations and Electronic Processing
Erin Hardie and Kris Kuntz, St. Vincent de Paul Village, San Diego, CA
Questions and AnswersFacilitators: National SOAR Technical Assistance Team
Strategies for Collecting Medical Evidence
Kristin Lupfer and Will ConnellyNational SOAR Technical Assistance Center
Policy Research Associates, Inc.
SOAR Critical Components
Serving as the appointed representative
Collecting and submitting medical records
Electronically submitting applications and medical evidence whenever possible
Collaborating with physicians for assessments and medical information
Collaborating with SSA and DDS
Submitting a Medical Summary Report
The Heart of Disability Determination
Medical evidence is the heart of disability determination
Diagnosis and resulting impairment are determined through medical records
Only physicians and psychologists (and some other health professionals) can make diagnosis
Other health care professionals can provide valuable information on functional impairment
Possible Paths to Medical Evidence
Applicant
Friends/Family Members
Service Providers
Commonly Used Facilities
State Mental Health Departments
SAMHSA
Internet Search Engines
Yellow Pages
Collecting Medical Evidence
Make list of treating sources
Have applicant sign two releases for each treating source (agency release and SSA-827)
Use cover letter explaining request
Send releases to medical records departments
Follow up weekly on information not received
Organize records chronologically and review
Continue to identify new sources of information
Maintain contact with DDS
Useful Evidence for Determinations – Medical Evidence
Psychiatric evaluations
Physical health evaluations
Specialty physical health evaluations
Neurological work-up reports
Laboratory results
Diagnostic tests
Neuropsychological tests
Psychological tests
Admission summaries
Discharge summaries
Progress notes
HIPAA Compliant Process
Case managers request records with a “compound authorization”
Records that are sent to the case manager can then be forwarded to SSA and DDS
HIPAA FAQs guide available on the SOAR website
Submitting Records Electronically
When possible, submit records electronically through SSA’s Electronic Records Express (ERE)
Request bar coded cover sheet from DDS examiner
Fax records directly into the applicant’s electronic file
Engaging Medical Records Departments
Medical records offices play an important role in the delivery of quality care
Their role frequently goes unrecognized
Offices are often overburdened
Empathy and kindness are invaluable
Engagement Strategies
Offer to pick up records when ready
Offer to copy records
Engage staff in conversation
Say “hi” even when no requests are pending
Remind staff how critical they are in process
Bring flowers!...candy, brownies, etc
Report to higher-ups that staff help agency receive more Medicaid dollars
Effective Engagement
Time invested pays off
Same day or same week records expedites applications
Free or discounted records
Better chance to obtain entire record
Helps everyone have a better day!
Other Engagement Strategies
Contact directors of records departments
Invite reps to local SOAR planning group
Negotiate a new process for collection
Honor agreed upon process
Set goals and monitor processing times
Collaborating with Local Hospitals
Tarry TruittMercer Alliance to End Homelessness
Lawrenceville, NJ
Mercer County SOAR Project
The Mercer Alliance to End Homelessness
Reached out to hospitals to collect data on emergency room usage by individuals experiencing homelessness
Emergency Rooms- High Users
Hospitals reviewed emergency room usage for high users
Provides opportunity to discuss SOAR and all strategies for homeless and general assistance individuals
Goal is to create a medical home for high users
SOAR Steering Committee
Created a Mercer County SOAR Steering Committee
Asked local hospitals to join the committee
Hospital Collaboration
Reached out to each of the local hospitals’ medical record directors
Explained the SOAR Project for homeless or general assistance clients
Asked the hospitals to participate in Mercer County’s SOAR project
Hospitals agreed to provide records free of charge
Multi-Provider Release and Procedures
Used one of the hospital’s release forms as a template to meet HIPAA requirements
Provider names are at top -- client circles all the hospitals or agencies they used
Created handbook with medical records procedures for each facility
Interagency Collaboration
Created request form to share client names among Mercer County SOAR caseworkers
Will prevent duplication of applications
Will provide information about clients using more than one agency
Central Point of Contact
Mercer Alliance is liaison for problems and issues
Hospitals call us with issues
Caseworkers call us with issues
Allows all parties to stay focused on completing applications or providing medical records
Social Security’s Electronic Records Express
David Vinokurov, District ManagerSocial Security Administration
Trenton, NJ
Electronic Records Express
What is Electronic Records Express (ERE)?
•Web based vehicle for submission of medical records to the electronic folder (EF)
•Can be used at the Initial, Reconsideration, and Hearings levels
•Is available for most medical and third party providers
Submitting Health Records Electronically
•Submitting records electronically is more efficient and timely, and can result in quicker decisions for applicants
•Electronic processes can make it quicker and easier for records to be transferred securely, eliminate mail time and automate handling so applicants receive a decision sooner
•Electronic processes benefit providers by reducing the time and costs associated with paper submissions
ERE Secure Web Site
• A secure connection using an industry standard encryption method (SSL, 128-bit encryption)
• Can be used via a standard Web browser and Internet connection
• Providers can submit Individual and/or groups of files
• No cost as it does not require postage or other costs
• Users need to be registered
ERE – Sign In
Interactive Demo
ERE Contacts
•If you are not already doing so, Social Security urges third party providers to submit health records electronically
•For more information about the options available for submitting records electronically, contact the Professional Relations Officer in your state’s Disability Determination Services (DDS)
• For more information visit: http://www.ssa.gov/ere/
Collaborating for No-Cost Records
Patrick HalsmerNew Mexico Human Services Department
Lisa HuvalNew Mexico Coalition to End Homelessness
Albuquerque, NM
March 2010: Identified most appropriate contacts within UNMH for discussions on medical records request process
UNMH Contacts:
Administrator of Behavioral Health Services
Director of Community Based Services
Contact initiated by Co-Chairs of NM SOAR Steering Committee
New Mexico SOAR and University of New Mexico Hospital Medical Records Request Process
March 2010 initial meeting between NM SOAR and UNMH
Built on UNMH’s awareness of NM SOAR (some staff already SOAR trained)
Mutual agreement to proceed with specific details of possible process that would include records without charge
Initial Meetings
What we asked for:
New Mexico SOAR:
Free records
Expedited processing of record requests
UNMH Medical Records Dept. Contact
UNMH:
Cover letter to identify requests
Allowance for standard processing time
Contact person in UNMH Medical Records Department
Free medical records
Satisfactory response time (2 weeks)
Submission via fax
What we received:
Each request includes 3 forms:
1. NM SOAR Cover Letter for UNMH Requests
2. UNMH’s specific medical release form
3. SSA-827 Authorization to Disclose Information
All requests may be Faxed to UNMH
Response within 2 weeks of request
The Process
May 27, 2010: NM SOAR/UNMH process announced; instructions and forms provided to NM SOAR Representatives
Few problems, simple solutions: Problem solving done by easy communications between NM SOAR and Hospital contacts, and SOAR Reps
Process in regular use
Implementation
Next NM Hospital: Presbyterian (a key statewide network of hospitals)
Will require MOU: Based on UNMH Process
1st Meeting in June 2010: Interest in process
Continued minimal contact during fall 2010
January 2011: Drafting MOU
Expansion
Internal Collaborations and Electronic Processing
Erin Hardie and Kris KuntzSt. Vincent de Paul Village
San Diego, CA
Brief Background
St. Vincent de Paul Village (SVdPV) provides transitional and permanent housing along with an array of services to single adults and families.
Downtown San Diego, CA
1,000 people housed each night
Implemented SOAR in 2010
Federally Qualified Health Center with staff from UCSD
Requesting Records
Difficulty with obtaining free records
Collaborated with Med Clinic because of their experience
Hospitals/Clinics tend to share records between each other without charging
Case managers developed list of providers who had charged us
Began requesting records with Med Clinic letterhead not agency letterhead
Created internal system to ensure records get routed to the right case manager
Electronic Records
Using SSA’s Electronic Records Express (ERE) to send medical records directly to DDS
Our Med Clinic began sending CM’s electronic records
Scanned all records from outside entities to PDF documents
Store all records in one location on our network
Records stored even after client exits the program
Electronic Records Express
Easy, efficient, and secure way to send records
Local SSA was excited because it is less work for them
Created account for entire agency
Send Medical Summary Report along with any other records
Speeds up process with submitting MSR and records after application
Using ERE messaging system to communicate with DDS
Next Step for Electronic Records
Create a secure website so we can receive records electronically from outside sources• Case manager sends email with web link
for provider to upload records• Need buy in from hospitals/clinics in the
area• Saves resources
Questions and Answers
Facilitators:National SOAR Technical Assistance Center Team
Policy Research Associates, Inc.
For More Information on SOAR
Visit the SOAR website at www.prainc.com/soar
Or contact:
SOAR TA CenterPolicy Research Associates, Inc.
Delmar, NY518-439-7415