All programs should have income that results from the services they provide. In addition to revenue generated from services provided, SANE programs may need to look to other sources for funding.
Billing for Care of Sexual Assault Patients
SANE programs typically have three options for billing directly for services, but different options for reimbursement may exist in your state. SANE programs can bill a patient's health insurance company. All billing of insurance companies must be in compliance with VAWA regulations. As discussed in Chapter 4, under the Violence Against Women Act (VAWA), states must certify, as a condition for certain grant funds, that the state or another governmental entity bear the “full out-of-pocket costs” for medical forensic examinations. Although it is allowable for states to help fund the examinations through billing of a victim's personal insurance, the Office on Violence Against Women (OVW) strongly discourages states from requiring victims to use their insurance. In some cases, insurance billing can present a hardship for victims. For example, a victim of spousal rape may not want her husband to find out that she got a forensic exam. If the victim is forced to submit the claim to her insurance company, and she is on her husband’s insurance policy, he may receive a statement from the insurance indicating that she got the exam. In addition, billing departments need to ensure that victims do not receive bills for any out-of-pocket costs, such as copayments or deductibles.
In some states, programs may be able to bill the state Crime Victims Compensation program directly. State and federal monies derived from fines paid by convicted criminals fund these programs. The funds are used for victim services and to compensate victims for some losses that occur as a result of a crime.
In some jurisdictions, law enforcement or prosecution may pay for the evidence collection because they view it as a law enforcement function.
Billing and Coding Practices
In order to bill both insurance companies and victim compensation funds, the SANE program may need to provide itemized bills using standard health care billing practices. This means proper International Statistical Classification of Diseases and Related Health Problems (ICD-10), coding of charges. A list of ICD-10 Codes can be found at the end of this chapter.
Other Sources of Earned Income
SANE programs may provide other services that can be billed. Two common services are suspect examinations and expert witness fees.
These types of examinations fall outside the SANE's scope of victim sexual assault examinations. Existing laws and statutes may not cover suspect examinations in the same manner as examinations for victims. If the SANE program is involved in suspect collections, a fee schedule and a payment process should be discussed with the law enforcement or prosecuting agency requesting the examinations.
Expert Witness Fees
Because of their unique skills in administering forensic exams, SANEs are sometimes asked to provide court expert witness testimony and case consultation. This assistance may be requested by either a prosecuting agency or defense counsel, and could be outside the scope of their existing employer. When considering this type of potential work, it is important to remain within the individual's field of expertise. If employed by a medical facility, the SANE should take steps to advise their present employer of any involvement in court testimony or consultation. Depending on how this service is provided, the team may be paid for the nurse’s services or the nurse may be reimbursed directly. It is important to make sure that providing testimony is not a conflict of interest for a nurse who is a member of a SANE team.
Providing this testimony and consultation usually entails a fee schedule. There is a minimal amount of information in the public forum pertaining to fee schedules. These fees may vary from within jurisdictions as well as by the scope of the testimony and consultation requested. Any compensation should ultimately be determined by the nurse's work, education, certification, and experience.
If you are part of a hospital-funded program, then fundraising may not be a significant part of your program development. For community-based programs, fundraising is a critical component as the program identifies how to purchase equipment, provide nursing education, and fund basic administrative costs. Once a program is established, fundraising fills the gap between what the program earns by billing for the examination and the actual program costs. It is important to know if there are people who need to grant you permission if you want to do fundraising. For example, in a tribal community, tribal leaders may need to grant permission to raise money. SANE programs need to understand that they are part of a larger community, and should be aware when there are limited dollars for social programs, so their fundraising may impact the ability of other organizations to provide services. For example, a community fund might be willing to contribute to the SANE program, but only if they cut existing funding to rape crisis services and the Children's Advocacy Center. It is important to work with community partners to avoid creating an atmosphere of competition for limited funds.
Getting Started – How Will You Ask for Money?
Before you can ask for money, you need to have some sort of corporate entity established that can accept the money. Most corporations or foundations will not give to an organization unless they are recognized as a not-for-profit, tax-exempt organization by the Internal Revenue Service (IRS). It can take 3 to 6 months or longer to receive approval from the IRS after an application is submitted. If you are part of an existing nonprofit, such as a rape crisis center, you will need to work closely with them to see if they will allow donations for your program to be designated for your use.
It is possible to use another organization's tax-exempt status to raise funds for your SANE program initially. This concept is called a fiscal sponsorship. It is both helpful and recommended to have legal counsel during the process of creating your nonprofit and if you decide to create a formal relationship with an existing nonprofit. There are also many web-based organizations with free information about starting nonprofits and fundraising in your community.
In addition to obtaining tax-exempt status, 40 states require charitable organizations to register with the state before they can solicit individuals for funds. A SANE program that serves more than one state will need to register in all states where they plan to solicit donations. If a program solicits donations on a website, they may be required to register in all 40 states.
Sources of Fundraising Money