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Social Security Disability: Collection of Medical Evidence Could Be Improved With Evaluations To Identify Promising Collection Practices

Social Security Disability: Collection of Medical Evidence Could Be Improved with Evaluations to Identify Promising Collection Practices

GAO-09-149 Published: Dec 17, 2008. Publicly Released: Dec 17, 2008.

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Highlights

The timely collection of relevant medical evidence from providers, such as physicians and psychologists, is key to the Social Security Administration (SSA) process for deciding whether an estimated 2.5 million new claimants each year have impairments that qualify them to receive disability benefits. The initial determinations are generally made by state agencies called Disability Determination Services (DDSs). We evaluated: (1) the challenges, if any, in collecting medical records from the claimants' own providers and ways SSA and the DDSs are responding to these challenges; (2) the challenges, if any, in obtaining high-quality consultative exams and ways SSA and the DDSs are responding to these challenges; and (3) the progress SSA has made in moving from paper to electronic collection of medical evidence. We surveyed 51 DDS directors, visited 5 state DDSs, reviewed sample case files, and interviewed officials with SSA, DDSs, and associations for claimants and providers.

Recommendations

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Social Security Administration	To foster timely and effective collection of medical evidence for disability determinations, the Commissioner of SSA should identify DDS medical evidence collection practices that may be promising, evaluate their effectiveness, and encourage other DDSs to adopt effective practices where appropriate. As a part of these evaluations, the Commissioner should work with the DDSs to find cost-effective ways to gather consistent data on the effectiveness of DDS medical evidence collection activities. Such data should include key indicators, such as the proportion of requests that yield medical records, the timeliness of medical record receipts, and how frequently claimants fail to attend consultative exams.	Closed – ImplementedActions that satisfy the intent of the recommendation have been taken.In 2009, SSA concurred with this recommendation, described some efforts to identify promising practices, and agreed to find ways to gather consistent data on the effectiveness of Disability Determination Services (DDS) medical evidence collection activities. However, it noted challenges with gathering consistent national data because there were five separate DDS case processing systems at that time. In FY 2010, SSA continued to develop a common disability case processing system that would provide consistent management information on medical evidence collection practices. SSA reported in FY 2011 that it held an annual national meeting with DDS Medical Professional Relations Officers to... discuss issues and share best practices, and conducted conference calls with the regional offices and DDSs as needed depending on the specific subject and audience of the call, to discuss issues and best practices. They encouraged the DDSs to notify their regional office contacts with issues and best practices that include medical evidence collection. They conducted pilots of new business processes to evaluate their effectiveness, and if successful, encouraged other DDSs or regions to implement these business practices. One example of this collaboration is the adoption of software programs developed by the Florida and Ohio DDSs to locate medical evidence that a medical provider submitted, but for various reasons, were not placed in the claimant's electronic folder. After determining the effectiveness of these software applications in locating medical evidence, the agency is now using them in all of the DDSs. In addition, they added functionality to the Electronic Records Express (ERE) website to accompany the functionality of these software applications (these enhancements, known as Track Status of Submissions and Customer Status Inquiries, were implemented in July 2008). The Office of Disability Determinations (ODD) continues to host monthly ERE Support Calls to provide an informal forum for the ERE Customer Support team to share information with DDSs and SSA components. In January 2010, SSA began legacy system rollout functionality, which allows for requesting payment for CE and MER via the ERE website.

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Topics

Information Management

Aid for the disabledClaims processingClaims settlementData collectionDisabilitiesDisability benefitsDisability insuranceElectronic health recordsElectronic recordsElectronic records managementEligibility criteriaEligibility determinationsMedical examinationsMedical proceduresMedical recordsPaperwork reductionPeople with disabilitiesSocial security benefits

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