I listened with great interest the report on the CBS Nightly News tonight of the small, but growing number of physicians who are no longer doing insurance billing for the patients they see in their offices-- (The doctors professional fees). These doctors have found that by chargeing a flat fee to each patient who comes in they save $1000s in overhead. A Mississippi doc charges a flat fee of $40.00 per patient per office call. Of course all tests, etc are covered by insurance. The point is that by eliminating this part of the paper work, the business saves time and $$ in the long run and the physician actually comes out ahead profit wise, because he is not waiting for a watered down check from Medicare/caid or other health care providers--the deal is cash payment at time of service. I am willing to bet that these are the docs who operate small clinics with minimal staff... just like a self-employed person who has little, if any, resources to keep them viable over the long haul.
I do not believe that the self-employed nurse acting as a sub-contractor for an Agency, institution or physician is the one to be doing the insurance billing if her work is billable. It is the responsiblity of the Primary Agent(cy) who is requesting the services of the contractor. These are the people who pay other people to do the billing. Believe me, if I had to do the billing for my Medicaid clients, it would be reflected as an additional charge to my fee for services--a whopping big charge, it would be, too!
The problem for the entrepreneural nurse is start up costs and making some kind of living wage while getting her business onto it's feet. It is uncommon for anyone to be able to start their own grass roots business without having to work a 'real' job at the same time. So, in most cases, we use our 'spare' time to build up our businesses while working for someone else.
I knew that the work I wanted to do would not be covered by any health insurance provider because it is not considered a 'skilled' care when provided by a nurse--it is considered skilled when performed by a podiatrist. Well,--I knew that the demand for the type of nursing service I could provide was high-and that people would be willing to pay out of their pockets for it IF it was a fair and reasonable charge. By calculating the initial outlay for the supplies I would need and factoring in the size of the territory I was willing to cover, I saw that I could more than likely make more money on my own than I was making working for an Agency. #1: I could control my territory-decreasing mileage and car maintenence expenses; #2: I could control supply costs; #3: I could put 10% of my earnings into a savngs account, letting it earn interest and put the rest into my household to help with bills, food, etc; #4: I knew that everything, everything, everything which reflected back onto the business was deductable--even the laundry soap I used to wash my work clothes. I also knew that I would show a loss at tax time- that loss coupled with my deductions would give me money back from Uncle Sam.
I also knew that the people who used my services were telling other people about my services and so those people wanted my services and people they knew wanted my services and so on, and so on, and so on. Word of mouth saved me a bundle in advertising. There is much more I can tell you about how my business grew, but will save it for another post perhaps.
I think that people will pay for convenience--especially if it is unique and offered in the home setting. I think that if a nurse has a PARTICULAR skill that she can provide ALONG with other cares-or whatever it is she feels she wants her business to be primarily-she will have a foot in the door of successful self-employment.
What I want to read in these posts is what are you are thinking about as far as self-employment? What is it you want to do as a self employed person? Describe the venture. Even if it's only an idea at this stage.
It takes a particular type of person to wing it alone...it takes an independent spirit, a trust in ones own skills and a deep desire to be free of the one thousand entanglements that prevent a nurse from providing the care she truly wants to give people--to be able to practice her science and art as a free agent...to be as unencumbered from bureauacratic clutter as possible.
I cannot believe that out of all the nurses posting on this BB, that only a handful have considered self-employment as a professional career option. But, we shall see as time goes by--it is vital that I hear from all of you...because, for a long time I have felt that certainly I AM the only independent out here...and frankly, it's been damn lonely. So there, I've said something! D