At RCA we find that prior to our partnership, many of the facilities that we work with were missing out on having their patient’s prior dates of service covered by retroactive Medicaid benefits. This often stems from the fact that their current vendor or in-house team is not well versed in the intricacies of the Social Security Administration nor in the process of filing timely claims and appeals. With RCA this has never been a problem because we have our own trusted and accredited representatives, who have extensive knowledge of the Social Security Administration’s laws and regulations.
Although it is assumed that Social Security Disability benefits are paid as a result of age, only 28% of the recipients are age 65 or older. In the SSI program, a disabled recipient is still classified as “disabled” after reaching age 65 but in the OASDI program, DI beneficiaries are converted to the retirement program when they attain full retirement age. To qualify for SSDI/SSI an individual must be disabled and unable to work for a period of at least 12 consecutive months (or have a condition that is expected to end in death) due to a physical and/or mental disability. The difference between an SSDI and SSI claim is extremely important with regard to how that case is worked up by the representative. Further, the knowledge of such claims is vital to a facility because it is imperative that a representative know whether benefits can be retroactive.
At RCA, we pursue benefits for adults and children who are disabled. However children’s cases are handled differently, primarily because we are not trying to prove they cannot work. Regarding children’s cases, we tend to look at how they function when compared to their peers. Often we ask ourselves are they “meeting milestones”, or if they are school age – are they “performing at grade level.” The Social Security Administration has a Listing of Impairments (found within the Social Security Act) that outlines impairments that automatically deem someone disabled. Part A was created for adults whereas Part B has separate disability listings for children. If a child’s medical condition does not meet the requirements of a disability listing, the child may still be deemed disabled if it is found that they have functional limitations that are “marked or extreme”. These limitations must severely affect the child’s ability to function on a daily basis and oftentimes your employees may not be familiar with these requirements. This is why it is so important to have a trusted partner who can provide representatives who possess the knowledge and experience to represent all cases, whether they be for children or adults.
If you have been injured or diagnosed with an illness which stops you from going to work and earning a living and you believe you qualify for social security disability benefits, don’t expect your claim to be automatically approved. In fact, the majority of claims are denied at the initial level. However, we are well versed in the process of filing timely appeals, interacting with the Disability Determination Services (DDS), and representing claimants at the hearing level. Regardless of whether your patient is an adult or child, we have the knowledge and resources necessary to aggressively pursue claims and get your patients the money and medical coverage that they deserve. Partnering with RCA ensures that you are protecting your at-risk dollars and covering prior dates of service for your patients.