Forensic Rape Exam (FRE) Frequently Asked Questions

Forensic Rape Exam (FRE) Frequently Asked Questions

Is it necessary to file a police report to qualify for coverage through the FRE Direct Reimbursement Program?

Is it necessary to file a police report to qualify for coverage through the FRE Direct Reimbursement Program?

No. OVS will accept the Medical Provider Forensic Rape Examination Direct Reimbursement Claim Form, along with the itemized bill, as documentation of the sexual assault forensic examination in lieu of a police or criminal justice agency report and will provide direct reimbursement for the forensic examination to the healthcare provider.

Does a sexual assault survivor have to use Medicaid or apply for Medicaid to pay for the forensic exam?

Does a sexual assault survivor have to use Medicaid or apply for Medicaid to pay for the forensic exam?

No. Sexual assault survivors do not have to use their private insurance benefits, Medicaid, Medicare, HMO (Health Maintenance Organization) or any other insurance program for payment of the forensic exam especially if it would interfere with personal privacy or safety. A sexual assault survivor may be asked to provide such information for medical care or services that are not related to the sexual assault forensic examination and not billed by the provider as part of the direct reimbursement claim.

Does a sexual assault survivor have to file the regular application with the Office of Victim Services to ensure payment for the forensic exam?

Does a sexual assault survivor have to file the regular application with the Office of Victim Services to ensure payment for the forensic exam?

No. Medical providers should advise sexual assault survivors that consenting to bill OVS for the FRE does not automatically make them eligible for any other compensation benefits available from OVS and should encourage survivors to file an application with the agency. OVS can assist with reimbursement for loss of personal property, loss of earnings or support, and expenses associated with counseling, in addition to medical care, if a regular application is filed. 

What is an itemized bill?

What is an itemized bill?

The itemized bill should be in the same form and substance as that billed to NYS Medicaid.  It must include a billable code and charge for each line item (e.g., it is not acceptable for “pharmaceuticals” to be listed as one item), the sum total of all charges, and a valid sexual assault or sexual abuse diagnosis code.

What services are included in the FRE Direct Reimbursement Program’s definition of a "forensic exam?"

What services are included in the FRE Direct Reimbursement Program’s definition of a "forensic exam?"

Facility services such as personnel, overhead, space, necessary supplies and use of equipment which are directly related to the sexual assault forensic examination. This includes an Emergency Room (ER) Physician for a survivor seen in the ER if the services provided by the ER Physician are related to the Forensic Exam.

Changes to the FRE Direct Reimbursement Program take effect on June 15, 2020.  How will my claim be processed?

Changes to the FRE Direct Reimbursement Program take effect on June 15, 2020.  How will my claim be processed?

The changes to the FRE Direct Reimbursement Program will apply to claims received by OVS on, or after, June 15, 2020.  Claims received prior to June 15, 2020 will be processed under the Program rules in effect up to that date.  Claims received after that date on the older or “legacy” claim forms will be returned to the provider to obtain the new information necessary after June 15, 2020.

What is the Medical Provider Forensic Rape Examination (“FRE”) Direct Reimbursement Program?

What is the Medical Provider Forensic Rape Examination (“FRE”) Direct Reimbursement Program?

New York State Executive Law (§631.13) provides for direct reimbursement by OVS to providers of forensic sexual assault examination services. The law requires the medical provider to explain the survivor's billing choices to them. When a survivor chooses to have the provider bill OVS directly for the forensic examination and its related charges, the provider shall use the Direct Reimbursement Program.

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