Strengthening Applications: Collecting Medical Evidence

1. Presented by: National SOAR Technical Assistance Center Policy Research Associates, Inc. Under contract to: Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services Strengthening Applications:Collecting Medical Evidence

2. Welcome Pamela J. Fischer, Ph.D. Social Science Analyst Homeless Programs Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

3. Webinar Instructions • Question instructions • Muting • Recording availability

4. 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 Answers Facilitators: National SOAR Technical Assistance Team

5. Strategies for Collecting Medical Evidence Kristin Lupfer and Will ConnellyNational SOAR Technical Assistance CenterPolicy Research Associates, Inc.

6. 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

7. 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

8. Possible Paths to Medical Evidence • Applicant • Friends/Family Members • Service Providers • Commonly Used Facilities • State Mental Health Departments • SAMHSA • Internet Search Engines • Yellow Pages

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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!

16. 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

17. Collaborating with Local Hospitals Tarry TruittMercer Alliance to End Homelessness Lawrenceville, NJ

18. 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

19. 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

20. SOAR Steering Committee • Created a Mercer County SOAR Steering Committee • Asked local hospitals to join the committee

21. 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

22. 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

23. 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

24. 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

25. Social Security’s ElectronicRecords Express David Vinokurov, District ManagerSocial Security AdministrationTrenton, NJ

26. 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

27. 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

28. 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 Inrequire postage or other costs • Users need to be registered • dividual and/or groups of files • No cost as it does not

29. ERE Secure Web Site • http://www.socialsecurity.gov/ere

30. ERE – Sign In

31. Interactive Demo

32. 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/

33. Collaborating for No-Cost Records Patrick HalsmerNew Mexico Human Services DepartmentLisa HuvalNew Mexico Coalition to End HomelessnessAlbuquerque, NM

34. New Mexico SOAR and University of New Mexico Hospital Medical Records Request Process • 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

35. Initial Meetings • 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

36. 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

37. What we received: • Contact person in UNMH Medical Records Department • Free medical records • Satisfactory response time (2 weeks) • Submission via fax

38. The Process • Each request includes 3 forms: • NM SOAR Cover Letter for UNMH Requests • UNMH’s specific medical release form • SSA-827 Authorization to Disclose Information • All requests may be Faxed to UNMH • Response within 2 weeks of request

39. Implementation • 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

40. Expansion • 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

41. Internal Collaborations and Electronic Processing Erin Hardie and Kris KuntzSt. Vincent de Paul VillageSan Diego, CA

42. 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

43. 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

44. 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

45. 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

46. 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

47. Contact Info Erin Hardie erin.hardie@neighbor.org Kris Kuntz kris.kuntz@neighbor.org http://www.fatherjoesvillages.org

48. Questions and Answers Facilitators:National SOAR Technical Assistance Center TeamPolicy Research Associates, Inc.

49. For More Information on SOAR Visit the SOAR website at http://www.prainc.com/soar Or contact: SOAR TA Center Policy Research Associates, Inc.Delmar, NY518-439-7415soar@prainc.com