BASIC (03-86)

DI 43510.075 Payment for Medical Evidence

A. General

The 1980 Amendments provided that any non-Federal medical source, (hospital, clinic, laboratory, physician not in the employ of the Federal government, or other provider of medical services) which supplies medical evidence of record required and requested by the Secretary shall be entitled to payment from the Secretary for the reasonable cost of providing such evidence. This amendment is effective with respect to evidence requested at all levels of adjudication for title II disability claims on or after December 1, 1980.

In contacts with the FSP, and in response to their inquires, advise them that the foreign title II disability claimant is no longer responsible for payment of fees for MER if a fee is charged. Indicate that SSA will pay a reasonable fee to a non-Federal source for the cost of preparing a report of MER it requests or asks the claimant to request but not for the cost of the examination(s) upon which the report is based. Also, the claimant will be informed of the payment provision when he or she is requested to obtain MER. SSA will discontinue asking the FSP to obtain MER at the claimant’s own expense.

SSA will also purchase consultative examinations when additional medical evidence is needed for adjudication and not available from a medical source.

B. Foreign MER

The FSP will pay a reasonable fee for medical evidence of record obtained from a treating source, if a fee is charged. Vouchers representing payment of bills for MER will be routed by the FSP as shown in C. below.

C. Consultative examination obtained by FSP

Physicians who perform CE’s in foreign countries submit bills for their services and receive payment from the local FSP. Vouchers representing the payment of bills for services rendered by such physicians in disability cases are sent by the FSP directly to SSA, Division of Finance, OFR, OMBP, P.O. Box 47, Baltimore, Maryland 21203. If a voucher is inadvertently misrouted to INTPSC, it should be forwarded to the Division of Finance, OMBP, 2-F-7 Annex Building under cover of a form OF-41.

Occasionally, an original bill for the services performed by the consulting physician will be received with the medical report. If this occurs, the INTPSC examiner will send the misrouted bill to the appropriate FSP using a Form SSA-423A with an appropriate explanation. To avoid duplicate payments, the request to the Foreign Service Post should ask that payment be made only if the attached bill has not been paid in accordance with Department of State Foreign Affairs Manual 4 FAM 335 and 7 FAM 241.6-3d. Be sure to attach a photocopy of the original SSA-423-U6 to the SSA-423A and include the “Appropriation Number” and the “Allotment and Organizational Code” on the SSA-423A.

D. Travel expenses for foreign CE

Foreign Service Manual instructions provide that when travel in connection with a proposed examination would entail substantial costs, the foreign service post will consider all alternative means of obtaining the information and will usually proceed by the least expensive method. If the FSP needs advice on the method to be used, a report will be made by operations memorandum before the post will proceed with the examination.

Evaluate the alternative methods of obtaining the information and instruct the post by means of an SSA-423A or direct teletype to use the least expensive method which will secure the evidence needed for adjudication. Do not check any items in “Services Requested.” Enter the necessary instructions in the Remarks section of the SSA-423A. Use the proper diary code for follow-up requests to the FSP.

E. CE obtained by DDS

The domestic DDS will pay for the consultative examination or test from funds provided by the Social Security Administration.

F. Documentation and certification irregularities

When information is missing on the invoice, e.g., the claimant’s name and SSN are omitted, or the address is not complete, and the information is in file, the disability examiner should enter the items on the invoice and forward it to the Division of Finance, OMBP for payment. However, if the correct information cannot be clearly determined from the file, or if the certification statement is missing, the invoice must be returned to the FSP for verification. (Copies of the MER should be included to assist the FSP in identifying the source.) The invoice may be returned with any additional development requested from the FSP.

Border DO’s responsible for developing disability claims for residents of Canada and Mexico have instructions to forward invoices for MER directly to Division of Finance, OMBP. If a border DO, for any reason, includes an invoice for MER with the claim folder, the invoice obtained by the DO must also meet the requirements stated above. Each invoice must clearly identify the source, charges, claimant’s name and SSN, and must contain the certification statement. If items are missing, and cannot be obtained from the claims folder, or the certification statement has been omitted, the invoice must be returned to the DO for clarification.