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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.

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strengthening applications collecting medical evidence
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

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
Webinar Instructions
  • Question instructions
  • Muting
  • Recording availability

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

strategies for collecting medical evidence
Strategies for Collecting Medical Evidence

Kristin Lupfer and Will ConnellyNational SOAR Technical Assistance CenterPolicy Research Associates, Inc.

soar critical components
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
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
Possible Paths to Medical Evidence
  • Applicant
  • Friends/Family Members
  • Service Providers
  • Commonly Used Facilities
  • State Mental Health Departments
  • Internet Search Engines
  • Yellow Pages
collecting medical evidence
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
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
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
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
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
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
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
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
Collaborating with Local Hospitals

Tarry TruittMercer Alliance to End Homelessness Lawrenceville, NJ

mercer county soar project
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
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
SOAR Steering Committee
  • Created a Mercer County SOAR Steering Committee
  • Asked local hospitals to join the committee
hospital collaboration
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
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
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
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
Social Security’s ElectronicRecords Express

David Vinokurov, District ManagerSocial Security AdministrationTrenton, NJ

electronic records express
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 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
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
ere secure web site29
ERE Secure Web Site
ere contacts
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:
collaborating for no cost records
Collaborating for No-Cost Records

Patrick HalsmerNew Mexico Human Services DepartmentLisa HuvalNew Mexico Coalition to End HomelessnessAlbuquerque, NM

new mexico soar and university of new mexico hospital medical records request process
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
initial meetings
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
what we asked for
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
what we received
What we received:
  • Contact person in UNMH Medical Records Department
  • Free medical records
  • Satisfactory response time (2 weeks)
  • Submission via fax
the process
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
  • 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
  • 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
internal collaborations and electronic processing
Internal Collaborations and Electronic Processing

Erin Hardie and Kris KuntzSt. Vincent de Paul VillageSan Diego, CA

brief background
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
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
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 express45
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
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
contact info
Contact Info

Erin Hardie [email protected]

Kris Kuntz [email protected]

questions and answers
Questions and Answers

Facilitators:National SOAR Technical Assistance Center TeamPolicy Research Associates, Inc.

for more information on soar
For More Information on SOAR

Visit the SOAR website at

Or contact:

SOAR TA Center

Policy Research Associates, Inc.Delmar, [email protected]