What is a FROF?
Most clinics are familiar with a report of findings. Depending on the setup in the clinic, the doctor may examine a patient, complete a report of findings, and treat the patient, all in one day. Others may complete the exam and take time for some additional ‘thinking’ before presenting their findings and treatment options. That provider may schedule the patient a few days after the initial exam. It can vary depending on the type of patient and the condition. No matter the process, a critical component of successful reimbursement is to complete a financial report of findings with the patient in addition to a clinical report of findings. The doctor can conduct it, if necessary, but we highly recommend a ‘passing of the baton’ to another staff member. This way the provider can concentrate on the clinical side while staff focus on the financial side.
The New Patient Data collection process is the first step in gathering the appropriate financial data. With the Good Faith Estimate regulations, a clinic is legally bound to have a financial conversation with the patient from the initial phone call. A clinic can use this as a stepping stone to establishing a financial agreement with the patient through a FROF process.
Consider the Schedule
Understanding your office flow and processes will help you prepare adequate time to develop your patient’s FROF. Every office is different. Some offices have patients come back the following day to receive the doctor’s Report of Findings as well as the FROF, while others schedule the patient for the following week. Will your patients receive their FROF the day following the initial examination or at some other time interval? Keep in mind, that the No Surprises Act forces a clinic to offer a Good Faith Estimate in most cases. You may want to take advantage of that conversation to build a hybrid FROF.
Consult the Treatment Plan
When evaluating this portion, be realistic. In some clinics, the doctor finishes all charts and treatment plans by the end of the business day while others may wait until the day of the patient’s second appointment to finalize the Report of Findings (ROF) information. If the provider is handing the baton, the doctor must collaborate closely with the team member to establish a process that works with both their schedules. Team members should speak up if they need the treatment plan sooner in order to present the financial information properly.
Verify Coverage and Benefits
Consumer empowerment has resulted in regulations that require payers to be more transparent with benefits and coverage. It includes insurance cards with more information on them, payer portals that list fees for all services as well as patient responsibility amounts in clear concise language. This may make the clinic’s job much easier, but until the infrastructure is in place, the old-school way of verifying benefits is a necessity. How does insurance verification take place in your office? Do you have this information verified and ready before patients ever arrive for their first visit as KMC University recommends, or do you have a process for obtaining this information after the initial visit? Determine how far in advance you will need this information to properly prepare your FROF and work with those responsible for this information to develop a useful and timely system. Pay special attention to items that are considered non-covered services by the payer, such as laser therapy or functional orthotics.
Initiate the Appropriate Form(s)
The financial process should be presented professionally. Have clean copies of all forms and present the information in a clear and concise manner. You may want to have pre-made folders with the necessary information based on the patient’s insurance status. Whether patients are utilizing their insurance benefits or are uninsured, the FROF will require you to locate the recommended treatment plan and work from there. Outlined below are different types of patients and the forms you might need.
- Insured individual: Completed verification form outlining benefits and any out-of-pocket cost.
- Insured but limited coverage: Completed verification form and copy of, or link to the clinical guidelines and payer limitations, along with their out-of-pocket cost.
- Insured but limited reimbursement: In rare cases, if a patient were to choose a deluxe item, such as an upgraded, luxury version of functional orthotics, the payer may allow the beneficiary to pay the difference, up to the full retail price. This would require the provider to bill the HCPCS procedure code S1001. It would also require the provider to obtain a signed acknowledgment from the patient via an Advance Notice of Non-Coverage form. If the payer does not have an established form, default to the KMC University’s form.
- Insured but no coverage for orthotics: The verification form along with the patient’s policy or provider contract stating the service is not considered medically necessary. In order to pass the cost on to the patient, an Advance Notice of Non-Covered service form must be provided. If the payer does not have an established form, default to the KMC University’s form.
- Insured but choosing to utilize a Discount Medical Plan Organization Network: ChiroHealthUSA allows you to customize your own levels of discounts for member patients even on products that insurance may not cover. Use their assigned forms in addition to the Verification form.
- Insured but choosing not to utilize insurance: If the patient has requested that the clinic not bill a 3rd-party payer for any services they receive, they may be considered a self-pay individual as defined by the No Surprises Act. Offer a Good Faith Estimate and, if accepted, provide a customized form within the time period outlined by the regulation. If you are not familiar with this process, please consult the additional resources available on this topic in the KMC University member library.
Create a FROF Team and Provide Training
Once you have established a process, create a team to handle the FROF. Pick key people who are comfortable with financial discussions. Create scripting and train staff on how to manage financial discussions. Do not overlook the role each team member plays in the process, even those not assigned to conduct the FROF. Those who answer the phone and schedule have an important role in setting up the FROF process by gathering critical information and offering a Good Faith Estimate when necessary. Make sure the team member responsible for the FROF is not feeling rushed during the presentation. Confirm that all the forms are clear and easy to understand for the patient. Be sure to streamline this process for efficient delivery and practice scripting with staff.