Might not get much of a response....but I'll give it a shot!!:)

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    the only reason I say this is the competitive nature of Indepentent nurse owned/operated Vascular Access Agencies. But we have been in business for nearly 8 months now and are ready to look into servicing Critical Access and Secondary Hospitals....

    My question is in regards to billing for private insurance...I understand how it works in LTAC and SNF or even with MEDICARE or MEDICAID patients. But as Nurses are'nt considered "professionals" how does a hospital handle billing a private insurance patient for a contracted service?

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  2. 4 Comments...

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    Hi,
    I only know what I learned in management when supervising an Outpatient Treatment unit in a CAH...so, may not be completely accurate for your situation.
    As far as I am aware, the only thing you can bill for PICC insertions in a hospital setting is the appropriate CPT code, as is also the case with infusions, chemo, etc.
    The reimbursement is fixed, no matter what the expense....so, in my experience, it was not cost effective from a management perspective to pay an exhorbitant amount of money for a contracted PICC nurse when compared with training their own staff nurses.
    I would say that it depends on how much you would be trying to bill, but this is not a huge money making service line...
    Kathy
    lindarn likes this.
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    Thanks Kathy...that helps somewhat...I will say we have had a surprising amount of interest from our surrounding rural hospitals mainly because the cannot maintain enough volume to keep staff competent in thier training. This leads to delays in care or possibly issues arising during insertion attempts. Personally I think this is a huge growth opportunity for nursing espec is areas that have only one or small tertiary facilities.
    lindarn likes this.
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    Hi Rkealy. Would really like to pick your brain about start up for an Independent picc company for LTACs. Would you be willing? I have many of the same questions you had about start up and billing and it is impossible to get anyone to talk! Not sure my business will be able to start up due to all the unknowns, but would love to give it a shot! Let me know if I could contact you by email. Thanks!

    bcbentley48@yahoo.com
    lindarn likes this.
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    You better get in while you can. Many areas are starting to train and hire, Respiratory Therapists to do PICC Line Insertions, Midlines ,etc.

    Of course, paying them quite a bit less than the RNs who have been doing it.

    The issue seems to be, that the RNs, on the Hospital based PICC Line Teams, are older nurses, who went into the PICC Line Team, because it was M-F, 9-5. NO weekends, holidays, etc. You get the picture.

    The hospital wanted/needed, around the clock coverage, no instead of opening the PICC Team to other nurses in the hospital, screamed that there was a nursing shortage, and could not find around the clock coverage for the PICC Team.

    Their solution to the problem, was to offer the PICC Team to Respiratory Therapists, who jumped at the chance to learn, and be able to bill, for another procedure.

    It is now snowballing, and it is catching on across the country. Arizona has very lax professional practice laws, and the nurses could not stop it on he basis that it was not in the scope of practice for RTs to be taught PICC Line Insertion. They now do PICCs, Midlines, and other vascular access!

    Apparently, here in Washington State, the same thing is happening here.

    The BONs are just handing over our professional practice to anyone who wants it, and is keeping it a secret until it is a done deal, and there is no stopping it.

    Please search this section for very recent threads about RTs doing PICC Line Insertions.

    I was appalled!!

    JMHO and my NY $0.02.
    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW


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