Become Medicaid/Medicare provider - page 4

by JM3RN 102,032 Views | 95 Comments

Hello, I am new here. I am in the process of planning my own business, either home care (private duty) or care manager (I just became aware of this title; is anyone familiar with it?). I read in an old post that a nurse became... Read More


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    I am in Illinois. I applied for and got an NPI number. As posted previously, I contacted the State Medicaid provider office and asked if I could apply to be a provider as an RN, not an advanced practice nurse, and was told I could and they would send me an application packet. I received it and began filling it out and could not find a provider code for RN, so I called them. I was told in the phone call that as a "plain" RN I can't be a Medicaid provider, and there was no code for just an RN. I looked back on the Medicaid website for IL and found a code for an RN and called them back. They said they had that code crossed out on their provider list. So I don't know if at one time they did allow RNs to be providers, and now, for some reason have taken that away, or if there is a mistake that I have to get to the bottom of. I called back again to try to get to the bottom of things, and asked to speak to someone who could enlighten me. I was told the supervisor was not at her desk, and they took my number. I have not heard back yet, and will call again today. Does anyone have any insight into being a Medicaid provider in Illinois as an RN, not nurse practitioner or advanced practice, so I can do private duty and get reimbursed by Medicaid? Maybe it varies from state to state. Thanks - Joy
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    Quote from JM3RN
    I am in Illinois. I applied for and got an NPI number. As posted previously, I contacted the State Medicaid provider office and asked if I could apply to be a provider as an RN, not an advanced practice nurse, and was told I could and they would send me an application packet. I received it and began filling it out and could not find a provider code for RN, so I called them. I was told in the phone call that as a "plain" RN I can't be a Medicaid provider, and there was no code for just an RN. I looked back on the Medicaid website for IL and found a code for an RN and called them back. They said they had that code crossed out on their provider list. So I don't know if at one time they did allow RNs to be providers, and now, for some reason have taken that away, or if there is a mistake that I have to get to the bottom of. I called back again to try to get to the bottom of things, and asked to speak to someone who could enlighten me. I was told the supervisor was not at her desk, and they took my number. I have not heard back yet, and will call again today. Does anyone have any insight into being a Medicaid provider in Illinois as an RN, not nurse practitioner or advanced practice, so I can do private duty and get reimbursed by Medicaid? Maybe it varies from state to state. Thanks - Joy
    Joy,
    hi - i'm in NY & don't know the answer to your question - but I work as an LPN as a medicaid provider - so what you are saying doesn't seem right at all. An advanced nurse practitioner doesn't do the type of homecare that a "plain" RN or LPN does. Definately keep calling to get to the bottom of this - tell them it's just homecare you want to do - check out the PennySaver (do you have that in Illiniois - we do in NY) or Craigslist to see if people are looking for RN's/LPN's with a medicaid provider for homecare - if you do see those ads then the info you're getting for some reason is wrong. Good Luck! Lisa
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    I got a call from Medicaid and was told that in Illinois one has to be an advanced practice nurse "with additional credentials", they expect more training that other states. Interestingly our governor was impeached last year for trying to sell President Obama's Senate seet when he became President, as well as other misconduct. Interesting, different standards, I guess.
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    Quote from JM3RN
    I got a call from Medicaid and was told that in Illinois one has to be an advanced practice nurse "with additional credentials", they expect more training that other states. Interestingly our governor was impeached last year for trying to sell President Obama's Senate seet when he became President, as well as other misconduct. Interesting, different standards, I guess.

    This just doesn't sound right - what about homecare - trach care, giving meds via G-tube.... - there is NO homecare in your state??? They surely don't pay AP nurses to give regular nursing homecare.
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    There is homecare, but Medicaid won't pay for independent private duty nurses (RNs or LPNs) who perform skilled care. I believe from what I read that, of course, if you work for a home health agency Medicaid pays them for the allowable services, but then that's not private duty.
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    I work in Private Duty/Home Health nursing and I just LOVE it! It is one of our best kept secrets I live in Wisconsin and our website to obtain your provider number and info is http://www.forwardhealth.wi.gov

    Kim
    chevyv likes this.
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    can you bill medicare and insurance companies?
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    can you bill medicare and insurance companies?

    i don't know about medicare at all - but yes to insurance companies - i think you would use your npi# & then apply for an id# thru the insurance co that the family is using. i only know this because i almost took a private case that was paid by insurance - not medicaid.
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    Can someone tell me how to apply for GA? Or where to start googling
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    I've been an LPN independent provider in Ohio for 11-12 years. LPN's make the same as RN's. I can only bill Medicaid. I "think" Indiana has the same IP program, Florida and it sounds like Wisconsin does? It also appears Calif will let Rn's bill medicare and insurance company's as well. But I know nothing more about that.
    Nurse practioners can bill medicare and insurance in Ohio but not Rn's.
    If anyone know's more or something different let me know.

    I'm an RN now and I'm getting out of the medicaid IP work for various reasons. Tired of paying all my own taxes, need benefits and just need a change. But it was good money for a long time. There use to be no competition and now it's crazy. LPN's have moved to Ohio because of this reason. It's very hard to find IP cases now. Plus home health business is booming in Columbus!!!!!


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