1. How does it financially benefit a Physician to assist the disabled?
The disabled often lack medical care, because they have stopped working and therefore have no funds or medical insurance for medical treatment. The disabled, once adjudicated; can get health insurance through Medicaid, then Medicare insurance, the disabled prior to their adjudication by the Social Security Administration, often fall into the gap of having difficulty obtaining the evidence needed to prove to the Social Security Administration the severity and true nature of their affliction . If Physicians would be willing to treat a disabled person prior to his or her receiving disability benefits and honestly fill out one or two short forms to provide evidence of the disability, that doctor would help the disabled patient gather necessary evidence to get necessary medical treatment. In return, hopefully the physician obtain a life -long patient with a lifetime of Medicare Health Insurance once the patient is found to be disabled by the Social Security Administration.
2. I thought Social Security had their own doctors who determine disability; is that correct?
The doctors contracted to the SSA are usually general practitioners or family practitioners who do cursory physical examinations of claimants to see if they can see, hear, walk heel to toe, get on and off an examining table. Sometimes they may ask a claimant to grip the physician’s fingers or touch the claimant’s toes. The evaluation is a one shot, five minute deal and the physician is not one who knows the claimant or has a patient - physician relationship. The evaluations, at best produce ambiguously written information that hardly, if ever results in an Administrative finding of disability. These physicians often are afraid to write favorable observations and seem to think they are at risk losing their Social Security referral source. Moreover, the reports the SSA physician writes normally do not take into consideration the evaluations and treatment notes of the claimants treating physicians. They also do not specifically address that claimant’s Residual Functional Capacity for sitting, standing, walking, pain, memory and ability to concentrate. This is why the Administrative Law Judge pays little deference to reports filed by non-treating SSA doctors. It is noteworthy that the Rules pertaining to Judicial evaluations of patient evidence require the Administrative Law Judge to pay “great deference” and give “significant weight” to the regards and opinions of “Treating Physicians and Sources” to the extent that those opinions are consistent with the patient’s treatment records. This is why we specifically request our client who have treating sources to fill out “RFC” Residual Functional Capacity Questionnaires for our clients that can truthfully and factually relate what the claimants limitations are.
3. Am I, the Patient’s treating physician qualified to complete a Residual Functional Capacity form for my patient? Don’t I need to send the patient out for a Functional Capacity Evaluation?
The Social Security Administration (SSA) recognizes that Functional Capacity Evaluations (FCES) are costly and can reflect the bias of the technician who is not a medical doctor. As a consequence, the SSA puts great faith in the ability of treating physicians to determine the reasonable limitations on the Claimant’s ability to sit, stand, walk, reach, bend etc. based on the consistency of the patient’s clinical presentation and objective medical evidence of record.
The SSA actually encourages the patient’s treating physicians to complete Questionnaires that address Residual Physical and Mental Functional Capacity and will send such questionnaires out to treating physicians to complete. There are no special training or courses or outside source requirements to complete these forms. ALL that is necessary is just an honest knowledge of the patient and desire to provide a reasonable medical opinion as to the patient’s limitations. An Administrative Law Judge will consider the limitations along with all the other evidence in the claimant’s file. In order to make an Administrative determination of disability that will be based on the Claimant’s medical diagnosis, residual physical and/or mental capacities, and a determination that is based on all the above, the claimant is unable to perform work that exists in sufficient numbers in the National Economy. Thus, “Disability” is ultimately a Vocational issue that is applied to the medical evidence and opinions of record. If based on the claimant’s age, education, transferrable job skills and ability to read and write the English language and residual functional capacity there are no such jobs available in the National economy in sufficient numbers to accommodate the claimant with his or her limitations, the claimant is considered disabled pursuant to Social Security Disability Guidelines. So one can see how helpful the conscientious completion of an RFC form by a treating physician truly is.
4. When does the patient’s eligibility for Medicaid or Medicare benefits start?
Eligibility for Medicaid begins on the date the SSA determined the claimant was disabled. So for the two years immediately subsequent to the claimant’s first day of being disabled the claimant’s medical bills will be paid by Medicaid. (Example, John Doe applies for disability (SSDI and SSI) on 1/5/06 saying he was disabled 12 months prior on 1/5/05. On 1/5/07 the SSA determines John Doe was disable as of 1/5/05 as he alleged. John’s Medical bill between 1/5/05 and 1/507 are billable reimbursable under Medicaid. After 1/5/07 John Doe’s bills are payable through Medicare.)
On the second anniversary of the Claimant’s first date of disability as determined by the SSA (or upon reaching full retirement age whichever is first) the claimant becomes eligible for Medicare.
For further information on Medicaid, Medicare and supplemental insurance issues we invite you to visit www.insureflorida.info.
5. How can I learn more about Social Security Disability and issues involving payment for patient services under Medicare and Medicaid.
Our law firm has seven offices conveniently located throughout the Tampa Bay area. You can read more about us and find answers to common questions for treating doctors on this site www.disabilityattorney.net. We can also offer a half hour presentation to educate your staff about the Social Security system, as well as what your patients need to prove eligibility for obtaining medicare insurance as a disabled person. We also will be able to answer any of your Medicare/Disability questions thereafter. If you are interested in obtaining this information, please contact our office manager, Patricia Bretz at or office 888-NMM-LAWS or 813-264-5363.
We look forward to building a productive relationship with your office to help these disabled patients/clients obtain the medical and disability benefits they have earned and deserve. We look forward to hearing from you.