SSA Disability Applicants Require Rapid Response

Staff from the Social Security Administration's (SSA's) Office of Disability Programs met with APA staff this summer to ask for help in reassuring psychiatrists that complying with requests for medical information required for their patients' Social Security disability applications in no way violates confidentiality protections for patients' medical information as mandated by HIPAA (Health Insurance Portability and Accountability Act). Apparently SSA reviewers are often unable to process disability claims because physicians are reluctant to supply the information requested. This is the case even though the request for information is made on Form SSA-827, Authorization to Disclose Information to the Social Security Administration, which is signed by the patient.

When physicians fail to respond to requests for medical records, disability applicants encounter delays in being approved for and receiving the benefits to which they are entitled. Since close to 40 percent of all the disability claims received by SSA are based on mental impairments, it is especially important that psychiatrists understand how the process works and what is required of them. SSA recognizes the special concerns psychiatrists have about the confidentiality of patients' treatment records and has asked for APA's assistance in providing information to psychiatrists so they can respond to requests for medical information without hesitation. So here are the facts:

Although Social Security Disability Insurance (SSDI) is a federal program, the application process is conducted by state disability offices. This duality may account for some confusion, because the request-for-records letter from the state may not make it clear that the information requested is needed for an SSDI determination.

Generally, a patient who wants to apply for disability fills out an application at the local Social Security office. As part of this process the applicant is asked to provide contact information for all of the medical professionals who can furnish information related to the disability claim. The applicant also is asked to fill out the SSA-827 form mentioned above, which is good for one year. This is a legal document that ensures that patient confidentiality is honored. The state disability office sends this form and a request for information about the applicant to the medical professionals listed by the applicant. Sometimes a form is filled out for each medical professional listed by the applicant, but it is just as likely that the request for records will include only a copy of the form filled out by the applicant, which includes all the listed medical professionals. Either form is legal.

If you receive a letter requesting a patient's medical records that includes a form SSA-827, it is important to understand that it has been sent to you at the patient's request. Your patient has identified you as a medical professional who has information that can help him or her obtain the disability benefits applied for. The application cannot be processed until the requested medical information is received.

If you prefer to send a report on the patient's condition rather than a copy of the patient's medical record, all the specific information SSA needs to determine the validity of the patient's claim is listed online at<www.ssa.gov/disability/professionals/greenbook/ce-adult.htm>. Just scroll down until you get to the heading “Mental Disorders.”

SSA reviewers are not interested in your psychotherapy notes; they are interested only in the patient's medical record. Under HIPAA, psychotherapy notes must be kept separate from the rest of the patient's medical record and are defined as “notes... documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session.” Psychotherapy notes do not include medication prescription and monitoring, therapy session start and stop times, modalities and frequency of treatment, results of clinical tests, and summaries of diagnosis, functional status, the treatment plan, symptoms, progress to date, or prognosis.

If your psychotherapy notes are enmeshed with the rest of the patient's medical record, you are permitted to release them as well or you may redact the “psychotherapy note” portions before you send the medical record to the reviewers. SSA will not redisclose the medical records it receives to other entities or individuals without the applicant's prior written consent, except in the limited manner permitted by federal law and regulations.

More information about requests for patient records to support disability claims is posted at<www.socialsecurity.gov/disability/professionals>.▪