charging for disability forms and medical records

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promethius

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I received a call the other day from someone supposedly at the social security administration asking for medical records for one of my patients who filed for disability. What's particularly eye raising is that I had finished seeing this patient for the first time earlier that same day. I was informed that every state has a set fee that a medical practice can charge for sending medical records for disability determinations. Is that true? I have never heard of that before.

What is a fair fee to charge for sending medical records for non-medical reasons such as to lawyers? How about for filling out disability paperwork? I rather practice medicine than have to deal with all these extraneous requests, but maybe they are more par for the course because of our specialty. I know lawyers charge absurd amounts to write letters. I do not see why physicians cannot do the same if our medical records are being used for their monetary gain. I am curious to know everyone's thoughts on this issue.
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I would advise you to refuse that paperwork. It will steal all of your time and energy. I won't do it.
 
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promethius said:
I received a call the other day from someone supposedly at the social security administration asking for medical records for one of my patients who filed for disability. What's particularly eye raising is that I had finished seeing this patient for the first time earlier that same day. I was informed that every state has a set fee that a medical practice can charge for sending medical records for disability determinations. Is that true? I have never heard of that before.
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yes SSDA will only pay what the state has set into it's regulations. you can charge more, but they'll only pay what the state mandates, they can't deviate from regulations. they are only asking for copies of records, you don't have to fill out anything or do an eval, they take care of that through their own independent process. the disability process takes months so this patient had initiated this claim a long time before they saw you. they are shopping...
 
Medical records are medical records. Just charge what you charge for that and be done. If they want a letter or paperwork filled out, that's a completely different story. Charge as much as you want to make it worth your while or don't do it.
 
I tell them I don't do them...Besides, Mr Smith has spondylosis and facet arthropathy and had a fender bender and now wants a me to get involved in helping him navigate an horrendous governmental program that is rife with fraud?

I don't have to be the person to do any patient's "stuff" just bc they're my patient.

They can see their PCP who can refer them to someone else. I'm happy to provide my notes.

Also the 5 or 6 ppl who have asked me for this have been people I would never put my name on as being disabled. Age appropriate changes on imaging with a subjective complaint? Nah bruh...
 
painfree23 said:
And when they ask why what’s ur answer? Also, where do you direct them to go to get it done?
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I’m a pcp. I will fill out short term Fmla but not long term disability papers. I don’t do it because the paperwork is insane and I always explain to the patients that I am not a disability doctor. The goal for anyone trying to get disability is a odds with the government trying not to give it. Something I write incorrectly on a form can interfere with their ability to get it and I would hate to cost them their chance at getting disability. I say this very sympathetically with no room for negotiations. I advise them to contact the social security office or to google to find the name of someone who does do this. A disability doctor usually costs the patients more money than seeing me and that’s the real reason they want me to do it. My most recent patient wanted me to fill it out for his chronic back pain. He had seen someone who was going to charge a fee to fill it out.
 
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nvrsumr said:
What percentage of the time do you accept payment from a patient and fill out the form finding no disability?
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If they are not disabled I provide the appropriate R&Ls. Patients are told up front their chances and I will not fudge forms for them. Im a fierce critic but a staunch advocate.
 
When asked for my expert medical opinion I am paid in advance, review pertinent medical records/exam patient and render an opinion.

Cart is always before the horse in disability paperwork. The ethical thing to do for society and the patient is to take payment and then fill out paperwork and send in.
 
You can fill out SS disability paperwork.... but you shouldn't. SS disability is a completely independent, fully functional process and your involvement is unnecessary. SS receives claim and assigns a physician and nonclinical case manager who are employed by dept of social services. they review the case and ultimately make the final determination, but they first send out a medical records request (this is really all you have to do as a treating physician and you will be reimbursed for copying records) and then they send the claimant to a contracted 3rd party for specialized evals: psych, ortho, neuro, IM, etc. Those evals do not make a recommendation for or against disability, they document the history from records, a functional exam, diagnoses, and impairments (i.e. can sit for 6-8 hours, can't lift more than 20lbs, blind, deaf, etc) Those evals go back to SS and the case workers render a decision based on SS guidelines from all the data they have acquired. If no disability is granted, the claimant can appeal to court and an ALJ can overrule (hence all those lawyer ads you see for representation and promising a win)
If you fill out SS "disability paperwork" (might be gov't forms, might be lawyer forms, who knows???) you are most likely doing it incorrectly, opening yourself up to liability, and in general f'ing up the whole process because you have no idea how it actually works

TLDR - just send med records when asked and stay out of the process, the government actually takes care of this for you!
 
Ducttape said:
Financial. They pay you, you say they’re disabled. Even if they are not.
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Why would I do that for? I'm going to risk committing fraud and losing my license over a piece of paper? Who in their right mind would do that?

If I don't think they're disabled, then I don't fill out their paperwork. If I do, then I charge them a fee commensurate with the amount of time, effort, and skill directed to the activity.

If they don't like my fee, then they can go somewhere else and get it filled out--who knows--maybe for free. The point being, monetize the crap you don't like doing. If you REALLY get off filling out disability forms, then do it for free and follow your bliss. If you hate it, then charge $500/hr.

Why do people overthink this stuff?
 
The only way for a hospital employed doc to monetize this is to bring the patient back in for a follow up visit to complete the paperwork.
 
drusso said:
Why would I do that for? I'm going to risk committing fraud and losing my license over a piece of paper? Who in their right mind would do that?

If I don't think they're disabled, then I don't fill out their paperwork. If I do, then I charge them a fee commensurate with the amount of time, effort, and skill directed to the activity.

If they don't like my fee, then they can go somewhere else and get it filled out--who knows--maybe for free. The point being, monetize the crap you don't like doing. If you REALLY get off filling out disability forms, then do it for free and follow your bliss. If you hate it, then charge $500/hr.

Why do people overthink this stuff?
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Lol @ anyone double checking ur work this ever for disability paperwork
 
I hate doing the paperwork, but will if requested. I require and independent functional capacity evaluation be performed and I inform them my opinions are based on that. There is also a fee associated with my time for the paperwork. Most people decline to have this done.

If the FCE says they can do sitting work for 4 hours a day or whatever, I recommend that. Often that is not what the patient wants. I do not think pain is a reason for disability.
 
DOctorJay said:
The only way for a hospital employed doc to monetize this is to bring the patient back in for a follow up visit to complete the paperwork.
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Or 1099 it and have consulting business excluded from hospital contract. I mean, if you do work outside of work ... it should be legit. And worth it.
 
How often do you see patients who are requesting disability claim forms to be completed for employer provided or individually purchased disability income insurance policies? Do you or would you would treat those patients differently?
 
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Ducttape said:
my answer: I focus on improving your functioning and quality of life. by declaring that you are disabled, I have labelled you as not being functional and have failed in my treatment before we even get started.
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Best and most succinct answer
 
Does the same apply to DMV handicapped plates and placards? Do you charge a fee for that or say no to that or is it just the disability paperwork?
 
i love the question on the fmla forms asking “how often patient will have a pain flare and how many days will they need off work?”

I just say that I cannot portend the future
 
lobelsteve said:
Or 1099 it and have consulting business excluded from hospital contract. I mean, if you do work outside of work ... it should be legit. And worth it.
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Excellent point. My hospital specifically forbids this type of stuff. Show up for your W2 and go home. Anything outside must be reviewed by chairman then admin then all payments go to hospital then our paycheck. Capped at $10k.
 
On the front office window is a sign that reads: Don’t mention disability unless I do so first.

If someone is in the process already, refer for FCE and then use those findings for any paperwork. It’s a dirty business for sure.
 
DOctorJay said:
Excellent point. My hospital specifically forbids this type of stuff. Show up for your W2 and go home. Anything outside must be reviewed by chairman then admin then all payments go to hospital then our paycheck. Capped at $10k.
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I had an LLC up and running long before the hospital gig. Just had it excluded and signed a no coi.
 
lobelsteve said:
I had an LLC up and running long before the hospital gig. Just had it excluded and signed a no coi.
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This is great for you, but doesn't sound common. Interestingly, all medicolegal work passes directly thru to us in my system. I think they did it so the Ortho guys would have some incentive to complete WC paperwork/ratings. I'll take advantage while it lasts.
 
First stop: FCE. Which cannot even be done in my small town, have to travel an hr away to do it. It takes all day to do. Also many of the insurance plans here dont cover much of it. Thus far, i havent had anyone actually go thru the FCE esp when they hear they have to pay hundreds of $ for it. Second stop (would be): come in for a followup visit for me to fill out the paperwork. Any further paperwork (inevitably will keep coming in) would require followups bc I don't do any clinical work, even if its remotely clinical, for free.
 
So would you give a patient short term disability for something like a herniated disc? It seems like a slippery slope.
 
drusso said:
Have they been paying premiums on their policy?
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drusso said:
Have they been paying premiums on their policy?
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drusso said:
Have they been paying premiums on their policy?
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I assume so. But what does that have to with me signing off on it? I’m not a disability examiner and we all see this on a daily basis. I’ve always been upfront with patients and tell them what has been echoed on this thread. My struggle is if you do it for one why not for everyone?
 
MiddleOfNowherrr said:
First stop: FCE. Which cannot even be done in my small town, have to travel an hr away to do it. It takes all day to do. Also many of the insurance plans here dont cover much of it. Thus far, i havent had anyone actually go thru the FCE esp when they hear they have to pay hundreds of $ for it. Second stop (would be): come in for a followup visit for me to fill out the paperwork. Any further paperwork (inevitably will keep coming in) would require followups bc I don't do any clinical work, even if its remotely clinical, for free.
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So u charge for prior auths, peer to peers, patient calling about a procedure related question post op? These seem remotely clinical
 
HouseofPain said:
I assume so. But what does that have to with me signing off on it? I’m not a disability examiner and we all see this on a daily basis. I’ve always been upfront with patients and tell them what has been echoed on this thread. My struggle is if you do it for one why not for everyone?
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If anyone buys an insurance product should they expect it to perform and function when they need it? It seems that if the medical necessity is satisfied, why should any doctor throw sand in the gears? Do you think that the insurance company knew what kind of business it was getting into when it asked the state insurance regulator for a license to sell policies to the public?

Am I missing something?
 
drusso said:
If anyone buys an insurance product should they expect it to perform and function when they need it? It seems that if the medical necessity is satisfied, why should any doctor throw sand in the gears? Do you think that the insurance company knew what kind of business it was getting into when it asked the state insurance regulator for a license to sell policies to the public?

Am I missing something?
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I agree. I had a patient come in a couple of weeks ago with a legitimate herniated disc. Another physician took him off work. I saw him for the initial evaluation told him I don’t do time off, disability but I would treat him. Agreed with treatment plan now the original physician won’t extend his time off and the patient is demanding I fill out his short term disability papers? Never agreed to do it and don’t feel obligated to do it. What action would you take?
 
HouseofPain said:
I agree. I had a patient come in a couple of weeks ago with a legitimate herniated disc. Another physician took him off work. I saw him for the initial evaluation told him I don’t do time off, disability but I would treat him. Agreed with treatment plan now the original physician won’t extend his time off and the patient is demanding I fill out his short term disability papers? Never agreed to do it and don’t feel obligated to do it. What action would you take?
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For some of these people they rely on mobility to earn a living, and short term disability can mean being able to make rent. I don’t like doing it, but when there is clear pathology I will.
 
callmeanesthesia said:
For some of these people they rely on mobility to earn a living, and short term disability can mean being able to make rent. I don’t like doing it, but when there is clear pathology I will.
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Do the insurance companies not have their own physicians that review claims? Im more than happy to give them a copy of records but don’t see the need for me to determine that. It goes back to the slippery slope argument. I see patients with legitimate complaints everyday that work. Do they all qualify for FMLA/disability because the have pain and their job is physical?
 
HouseofPain said:
Do the insurance companies not have their own physicians that review claims? Im more than happy to give them a copy of records but don’t see the need for me to determine that. It goes back to the slippery slope argument. I see patients with legitimate complaints everyday that work. Do they all qualify for FMLA/disability because the have pain and their job is physical?
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If you're a physiatry-trained pain doctor, determining disability is kind of a core competency...but if you're anesthesia you might want to defer.
 
drusso said:
If you're a physiatry-trained pain doctor, determining disability is kind of a core competency...but if you're anesthesia you might want to defer.
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drusso said:
If you're a physiatry-trained pain doctor, determining disability is kind of a core competency...but if you're anesthesia you might want to defer.
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Anesthesia trained
 
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