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- Mar 4, '03 by JNJDiane:
You've got to explore this independent option again. If CA Medi-Cal is approving LVNs as independent nurse providers, your state can't be far behind.
I've been an INP since March 2002 and love every minute of being a nurse all over again - a 30 yr. veteran. Like you, I was independent a few times in the past too. seemed to get sucked in too often by a nurse teaching position or something that sounded like new technology etc.
I've recruited two other RNs to my field in CA; each is having a good experience. The documentation is not difficult, just a little tedious. Just go thru the hoops, one at a time and make an ally of your Nurse Evaluator person at the state office. Most of them are struggling with these new programs too. Help them to help you. Texas even has their forms on line. I had to teach the CA Medi-Cal Nurse Evaluator how to attach a file to an email, but they're doing well now!
Good Luck and power to you.
- Mar 5, '03 by nightingaleWhat is being spoken of here, is EXACTLY the reason and benefit I had hoped for this forum.
Thank you.. thank you... posters!
- Mar 11, '03 by LoisJeanGreetings, All;
My services are paid for under my State's Home and Community Based Services program. These services are funded through a Federal/State funding program. My business is classified as a Community Service business.
I am sub-contracted to provide foot care as a Private Duty Nursing Service- (note: NOT AGENCY.) I bid my services to them each year. Because of the type of nursing I do, there are as yet, no competition bids. My referrals come through the Case Managers (RNs) who have assessed the needs of clients who meet the criteria for this Waiver Program. The majority of those referred to me are diabetics. I use the billing form the Waiver agency provides. I send my billing directly to the agency office. They in turn pay my fees out of the Medicaid fund used for this purpose. I am paid once a month. I am audited by the State on an average of every three years. They have a set criteria of what they want each community service and agency to adhere to regarding the contract agreement. In my case it is nursing notes, office protocols with emphasis on confidentiality, etc.
Because of Federal cutbacks to State Medicaid programs, we have seen some decrease in the number of visits (unit hours) which some community services provide. For example, nursing agencies have had to cut back on the number of times an aide could come in to provide a bath; or eliminated services in the home such as housekeeping. Maintainence services as well as Transport services have been cut back. Offen times these are the high bid areas which Medicaid cannot support now.
I say that when there is an independent agent, (nurse), who is able to UNDERBID the others, then that agent will have more sub contract work than he/she can handle.
Agencies cannot charge their fees and expect full reimbursement from Medicaid these days. They cannot lower their bidding fees because they cannot operate on a deficit. This is where Entrepreneural Nursing comes in. We can work for less and still make money and not just with Medicaid...
... Medicare will also be taking a long look at the Entrepreneural Nurse especially in the area of Private Duty. I think there will be some changes made in the issue of who can bill directly and who can't. I also think physicians are going to take a look at us. Because of the high cost of skilled nursing care in home, Medicare pulls out often long before the patient is ready to be discharged. The Entrepreneural nurse fills in the gaps. This is workable because the self employed nurse does not have to charge the fees- per visit/per type of visit- that an Agency charges.
I might be all wet with some of the above, but I feel very strongly that the day is fast approaching when the need for the independent nurse will be necessary...and I believe that NOW is the time for all nurses who dream of being self employed to get themselves started--no matter how small a venture it may seem at first.
This particular forum is here for those of us who are setting out to do something that smacks against the 'norm' of nursing as a profession and as a practice. Whether we are working directly with the community at large or behind the scenes, the idea of being self employed, self sustaining and self supportive is the ideal that motiviates us. Not all nurses want to be self employed, but ALL NURSES MAY BE SELF EMPLOYED.
- Mar 12, '03 by nightingaleAMEN... & ditto....
- Apr 13, '03 by crispixAs an LPN,tho,and I have just begun to check into this,but,it seems we are either not allowed to do this on our own,or we have to work under an RN.
I was wondering tho,if we work with the different clients physicans,like make out care plans,progress reports,objectives for treatment,etc...would that eliminate the need for the RN?
Nothing against RN's,but Id like to do this on my own,doing the care and billing,etc...what about Social Security,you know,making payments to it...for yourself,my mom does this,she babysits,and every 3 months has to pay in a certain amount.She goes thru an accountant,who she babysits for.
I might just give her a call myself,and see if she can help.
- Apr 14, '03 by nightingaleChristine:
Thanks for posting and WELCOME. Lois Jean is an LPN and I am sure, after she sees this post, will sapport your dream.
My suggestion is that you check with your local Chamber of Commerce and see how they can sapport you wil business information with "How To Run a Business". I completed a class a few months ago with "How to Write A Business Plan"; it covers many of the topics that will help you to organize, research, and get the sapport you need to run your business.
Also, try doing a search on this forum with topics regarding Entrepreneurship. On this Forum, you will find many answers and discussions that will help you.
Keep in touch and let us know how we can help.