SOAR Key Component: Collecting Medical Evidence

SOAR case managers play a central role in collecting medical evidence before submitting the complete application packet to SSA. In this way, when SSA completes its review for non-medical eligibility, DDS has the necessary information to make the disability determination. Remember the DDS examiner rarely meets the applicant and determinations are based solely on the medical evidence gathered.

Various aspects of the SOAR Model (including how to collect medical evidence) must be negotiated on the local level with SSA, DDS, and community providers. Contact your SOAR State or Local Lead to find out about your community's SOAR program: http://soarworks.prainc.com/directory
 
Advantages of SOAR 
SOAR facilitates the gathering of medical records prior to submission of the application packet to SSA. This ensures that DDS receives complete information without duplication of effort and as quickly as possible to assess whether the person’s physical and mental health problems lead to functional impairments that result in inability to work.
When case managers facilitate gathering of medical records, they can:
  • Often access medical records faster
  • Ensure that records are sent
  • Ensure that the information is relevant and complete, including information that is often overlooked, such as progress notes
  • Make an initial assessment about the available information
    • Does it substantiate the health problems? 
    • Does it provide documentation of functional abilities?
    • What information is missing, what needs clarification, and what needs further development? 
Representative Responsibilities in Collecting Medical Evidence
In addition to the advantages above, when a SOAR provider serves as the applicant’s Appointed Representative using the SSA-1696, his or her duties as a representative include assisting the applicant in gathering and submitting medical evidence to DDS.
  • The Representative Rules of Conduct states that a representative must promptly obtain and submit information and evidence to DDS
  • Representatives should make good faith efforts to obtain medical evidence, but if they are unable to do so (e.g. the medical center does not respond to the request or charges a fee that the provider cannot pay), then the representative can inform DDS about the evidence and DDS will reach out to the medical provider
Consider the following five steps that can greatly enhance collecting medical evidence, making it faster, more complete, and more targeted to the disability determination process.
 
Five Steps for Collecting Medical Evidence
1. Make List of Treating Sources
Make a list of the places where the person received treatment.
2. Obtain Releases for Medical Information
Have the applicant sign two releases for each treating source.
3. Send Releases to Medical Records Departments
If acceptable, fax or hand deliver releases for medical information to providers.
  • Contact current and past providers to explain the critical importance of obtaining complete information
  • Prepare “request packets” that include a cover letter and the two releases
  • Confirm receipt of fax or delivery, if mailed
  • Specify the type of information needed
  • Ask what you can do to facilitate quick receipt of records
  • A sample cover letter is available in the Library
  • Utilize the SOAR tool: Medical Records Tracking Worksheet
4. Offer Assistance to Medical Records Departments
Case managers can collaborate with medical records department directors to coordinate the information collection process. Offer assistance to alleviate the burden for busy medical records staff:
  • Offer to review records; this ensures that all relevant information is copied
  • Offer to make the copies or bring paper for records to be copied on
  • Offer to pick up the records at a designated place and time
  • Say “hi,” even when no requests are pending
  • Remind staff how critical they are in process
  • Bring flowers, candy, brownies, etc. to show your appreciation
  • Report to higher-ups that staff help the agency receive more Medicaid/Medicare dollars
5. Follow Up Weekly on Information Not Received
Follow up on records collection on a weekly basis until all information is received.
  • Continue to identify new sources of information (new sources may be identified or recalled; new problems may arise that need treatment)
  • Maintain ongoing and regular contact with DDS
  • Pass new information on to DDS
  • Inform DDS of sources that did not send information so that DDS can follow up
Fees for Obtaining Medical Records
Building relationships with medical records departments also helps SOAR providers arrange fee waivers and obtain records free-of-charge.
  • Meet with the medical records department manager or billing supervisor. Make sure you are speaking with someone who has the authority to waive fees.
  • Explain that the records are for an individual who is experiencing homelessness, has no income and needs the records to apply for disability benefits; ask that the fees be waived.
  • Remind them that when the individual is approved for benefits, the facility could be reimbursed for services provided.
For more information on state statutes and regulations regarding the collection of fees for medical records, click here.
 
Organize and Review Records
Organize records chronologically.
  • Place the most recent records on top
  • Remember that DDS requires a mental status exam within the past 90 days
  • Note what is missing and what needs clarification
  • Get assistance from a supervisor, the individual’s treatment provider, or a consultant (if needed); make sure to have releases for any reviewers
  • Incorporate all information in the Medical Summary Report
Summary
The SOAR process can have a great impact, resulting in timely and targeted information. The sooner a decision is made, the quicker the person can access services.