Screening Self-Pay Patients for Social Security Disability Benefits: A Win, Win, Win
Editor's note: This blog was written by Kim Williams, senior vice president and chief operating officer at Chamberlin Edmonds, an Emdeon Company.
The Social Security Administration's disability insurance programs, Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), have gained a somewhat lackluster reputation in recent years. Complicated applications and lengthy approval times lead some individuals to give up mid-process and others to not apply at all. Meanwhile the number of new disability benefit applications escalates each year, raising questions about the program's long-term sustainability.
We all agree that the potentially disabled patients seeking medical services are vulnerable, often isolated and unprepared to face a complex eligibility process. Most will need an advocate to help secure benefits. Perhaps this is why more hospitals and healthcare organizations are supplementing their current Medicaid eligibility activities with efforts aimed at securing federal benefits for their disabled patients. If eligible for SSI, patients can obtain Medicaid for current expenses and, after a two year wait, can become eligible for Medicare through SSDI. In addition to these medical benefits, patients will receive a monthly check ranging from $1 to $698 depending on individual circumstances.
Granted, securing SSI/SSDI coverage for patients can be difficult and involve a long wait. Most decisions take months to come to resolution - and if an appeal is filed, up to 2 years. Without an advocate many people give up if denied. Experienced eligibility personnel can not only ensure that the application is handled properly, but can assist the patient with a disability appeal. Data from the Social Security administration indicate that some denials are overturned at the first appeals level and 60 percent of hearings appeals result in approvals for disability benefits.
One South Carolina Hospital began an eligibility and enrollment program to offset mounting losses from self-pay patients. The organization began qualifying individuals for both Medicaid and SSI/SSDI coverage, with special emphasis on the latter due to deep cuts in the South Carolina Medicaid Program. Within the first year, eligibility consultants worked with more than 3,000 self-pay individuals, filing 900 total applications and achieving 711 approvals. Newly obtained coverage for these patients translated into $7.1 million in reimbursements that would otherwise have been classified as uncompensated care.
While it can be a long road from initial application through SSI/SSDI approval and benefits, screening self-pay patients for these benefits is a win/win/win.
For one, the service is a benefit for the patients who often lack the know-how and stamina to pursue assistance. Secondly, the patient has help with medical expenses through Medicaid and long range Medicare and receives a monthly check for living expenses. And finally, screening patients for SSI/SSDI eligibility is a tremendous asset for the healthcare provider as well - driving new income, reducing uncompensated care, potentially increasing Disproportionate Share Funding and reinforcing the mission of providing multidimensional benefits to the patient and the community.