DDSs generally pay providers for records and SSA pays the DDSs to cover  these expenses. In addition to medical evidence, DDSs review  statements from the claimant or others about the claimant’s impairment  and ability to perform daily activities. DDSs pay providers to perform these  examinations and SSA pays them to cover these costs. 2.) DDSs Face Challenges Obtaining Medical Records from Claimants’ Providers

Determining eligibility for disability benefits is a complex, challenging  task. DDSs have  responded to these challenges by conducting additional follow-up contacts  with medical providers and claimants, and more than half of the 51 DDSs  we surveyed reported adjusting their payment methods. Medical Providers Do Not Respond Consistently to DDS Requests for Records

DDS officials identified provider response to medical records requests as a  challenge in our survey of 51 DDSs. As a  result, the volume of records requested is high: 13 DDSs reported sending  over 200,000 requests in fiscal year 2007. Responses to these challenges include scheduling  consultative exams with medical providers whose practices focus  primarily on performing disability evaluations and adjusting payments, for  example, by paying providers for the time they spend preparing for a  consultative exam that a claimant fails to attend. For example, 41 of the 51 DDS directors we surveyed  reported that their offices routinely ask claimants’ treating providers if  they are willing to perform a consultative exam if needed, but 34 of these  directors reported that claimants’ treating providers are never or almost  never willing to perform these exams. One reason why the DDSs may face difficulty recruiting and retaining  consultative exam providers is the frequency with which disability  claimants miss their consultative exam appointments. Current payment rates also may contribute to the DDSs’ challenges  recruiting and retaining consultative exam providers who submit high- quality reports. SSA Has Made Progress in Moving to Electronic Collection of Medical Records, but Faces Challenges Shifting to the Use of Electronic Medical Records

SSA’s transition from paper medical records to the use of electronic  images of medical records has increased opportunities for program  efficiencies and agency collaboration. SSA Has Made Progress in Developing Options for Submitting Records Electronically, but More than Half Are Still Submitted on Paper

One of SSA’s goals is to receive all medical records electronically. In some cases, providers may  find this too time consuming to be feasible. One large provider accounts for most of the  records SSA receives online. We found  variation among the DDSs in the percentages of records received online. SSA, however, currently lacks some important  data necessary to evaluate these approaches and identify promising  practices, which might be shared to promote more timely and complete  collection of relevant medical evidence by all DDSs. Other major contributors to this report are  listed in appendix V.

Appendix I: Scope and Methodology

To determine how Disability Determination Services (DDS) and the Social  Security Administration (SSA) collect medical evidence, we used four  primary sources of information: (1) a survey of the 51 DDSs including all  50 states and the District of Columbia; (2) in-depth interviews and site  visits with 5 states; (3) a review of 100 randomly selected initial claims  files and 50 claim files at the appeals level; and (4) analysis of SSA data  concerning disability determinations. GAO Survey of DDS Directors on Collection of Medical Evidence for Initial DDS Disability Decisions

Our survey of DDSs addressed the timeliness of provider responses to  DDS requests for medical records, practices and challenges associated  with collecting medical records, practices and challenges associated with  obtaining consultative exams, outreach to the medical provider  community, and SSA and DDS initiatives associated with medical evidence  collection. These included data for  initial and reconsideration filings received, decided, and pending at year  end;  filings approved and denied; filings for which one or more medical evidence of record was purchased; filings for which one or more consultative exam was requested;    expenditures for purchase of medical records and consultative exams;    errors in DDS initial determinations identified by SSA quality assurance  the results of evaluations of medical records collected and consultative  exam reports by SSA quality assurance reviewers; and  responses to medical records obtained via methods, including paper and  faxed submissions, and online submission options such as SSA’s  Electronic Records Express Web site. GAO-04-14.
Why GAO Did This Study

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.

What GAO Found

Obtaining timely and complete medical records is a challenge to DDSs in promptly deciding disability claims, and DDSs have responded with additional provider contacts and adjustments to their payment procedures. Although DDSs pay most medical providers for medical records and SSA pays the DDSs to cover these expenses, 14 of 51 DDSs reported the percentage of requests for which they did not receive records was 20 percent or more in fiscal year 2007. In response to this challenge, all DDSs conduct follow-up with providers and claimants to urge them to provide records. Over half of the DDSs (34 of 51) have also implemented more timely payments for records and six increased the amount they pay. Although SSA evaluates DDS collection of medical records, it does not compile key data necessary to identify and share promising collection practices. Recruiting and retaining qualified providers is a challenge to obtaining consultative exams needed to supplement insufficient medical records. For example, 41 of 51 DDSs reported routinely asking claimants' own providers to perform these exams; yet 34 reported providers never or almost never agree to do so. DDSs directors in our survey believe that current payment rates account for some of the difficulty recruiting and retaining consultative exam providers. In response to these challenges, 32 DDSs rely on medical providers who specialize in performing disability evaluations, and 20 pay providers for time spent preparing for appointments claimants fail to attend. SSA evaluates evidence from consultative exams, but these evaluations and the data they yield are too limited to identify and share promising DDS practices. SSA has made progress moving to electronic collection of medical records, but faces challenges in fully implementing electronic retrieval and analysis of medical evidence. SSA now uses electronic images instead of paper copies of new claimants' records. Though SSA seeks to obtain all records electronically and provides options for online submission of records, only one large provider accounts for most of the records submitted online, and about half of all records received are on paper. To date, SSA has taken only limited action to identify and analyze the barriers providers face in using current electronic record submission options, and has not developed a strategy to address them. In the long run, SSA is participating in an advanced prototype to collect medical records in formats that can be searched and analyzed by electronically querying a hospital's records database and directly retrieving the claimants' records.