Social Security Disability and Health IT


Hi, I'm Monica Miles from the Health IT Program office at the Social Security Administration.  Health IT has become an important part of the way that we do business.   Let me explain how.  At Social Security our disability workload continues to grow while our workforce is shrinking.  Because of this, we've had to look for ways to leverage technology to better manage the workload.  We found that Health IT is a good way to do this.  I'd like to share with you the many benefits of using the eHealth Exchange to electronically provide medical records to Social Security.

While many organizations are working towards meeting the Center for Medicare and Medicaid Services, or CMS, criteria for meaningful use, organizations have the opportunity to leverage their efforts and realize additional benefits from an electronic exchange with Social Security.  We define disability as a mental or physical impairment that prevents an individual from being able to perform any type of work for at least a year or is expected to result in death.  Something that's important to note is that we only recognize 100% disability.

One of our challenges is to obtain the medical information that allows us to determine if an individual meets this definition.  In the course of a year, we request over 15 million records from medical treating sources.  So, as you can see, it's a pretty big business.  When a person contacts Social Security to file for disability benefits, we collect several key pieces of information, including their demographic information, along with facts about their allegation of disability, and a full list of their treating sources.

It's important to note that Social Security is not a HIPAA covered entity, but we are covered under the Privacy Act.  Because of this, we have the claimant sign an authorization that allows their healthcare providers to release information to us.  This authorization is then forwarded, along with the claim, to the State Disability Determination Service, or DDS.  This agency makes the medical determination on behalf of Social Security and is actually the office healthcare organizations interact with most frequently.

Now, here is how the process works:  The DDS sends requests for medical information to the healthcare providers identified by the claimant in the application process.  When the DDS receives the medical information, they evaluate it and make the disability determination.  In the majority of cases, this is still a manual process that is slow and cumbersome.  It takes on average about 90 days to process a claim with most of that time spent waiting for the medical information to be received.

By using Health IT to automate this process, we send an electronic request to the healthcare provider system, and information is returned in a standardized Health IT format within seconds or minutes rather than weeks or months.  One of the benefits of this process is that it lessens the burden on the healthcare provider to manually locate, prepare, and send records to us.  In addition, when a claimant appeals a determination and requests a hearing, we are able to use Health IT to request medical records from participating healthcare providers.  Also, by receiving the records within minutes, we're in a position to make a quicker determination on the claim.

We have already realized significant overall processing time savings.  So, as a result, we find that when someone meets our disability criteria, we're able to award benefits faster.  These include a monthly cash benefit, as well as potential healthcare coverage under Medicare or Medicaid, which, in turn, provides value to healthcare providers who care for these patients.  Often, these patients are uninsured or underinsured and fall into charity care or self-pay encounters.

With self-pay, there is often a higher likelihood for these bills to go into collections.  In addition to the provider now being paid faster for these services, this also helps the patient.  With quicker access to Medicare or Medicaid, patients may be more likely to seek needed treatment without worrying about the cost of their medical bills.

In addition to the potential for recovering uncompensated care costs through increased healthcare coverage for patients, we pay for successful Health IT transactions over the exchange.  These payments are made based on the amount designated in the Federal Register Notice, detailing the Uniform National rate.  We make these payments through an electronic funds transfer, and we provide a statement at the time of payment to help providers reconcile these payments.

The benefits of this automation have already been proven to Social Security, to the healthcare providers now using Health IT over the exchange, and to their patients.  Because this process is streamlined, it becomes a win-win for everyone.

I hope that you have found this information helpful.  If you'd like additional information about this process, and to view testimonials from our current Health IT partners, please take a look at our website at www.socialsecurity.gov/hit.

On the website, you will find a "Contact Us" form that collects your contact information and questions so that someone from our team can reach out to you.  Thank you for your interest.