Become Medicaid/Medicare provider

Specialties Private Duty

Published

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 a Medicaid/Medicare provider and apparently was able to use those resources as sources of payment. Does anyone know how you become a M/M provider? And, how fast do you get your payments from them?

Thanks

Specializes in Medical surgical.
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

Send me a private email, would like to talk to you re NY and homecare , i am a provider also. thanks

I am an LPN in ohio, wanting to get into independent work. How do I find an RN supervisor?

I am an LPN in ohio, wanting to get into independent work. How do I find an RN supervisor?

You don't find a supervisor - you find the case. In NY they may be advertised in the Pennysaver or Craigslist. For pediatrics it's the parents usually who most likely will be putting the ad in.

Specializes in medical/surgical/peds/neuro.

That's great to know more states do this. It's getting harder and harder to find cases in Ohio. They're changing how you bill and who manages cases. Plus there's too many nurses in Columbus. They're training aides to pass meds in home a well. Lot's of changes and cut backs in medicaid pay in Ohio too.

MerryMary where are you in Ohio! I just found this site and think its wonderful. i have been doing PDN for 8 years now with 3 clients. Maybe if you are close to my area we can swap info. i have plenty of hours and where I live it does not appear to be saturated as of yet

Specializes in Medical surgical.

Call the state office, "Medicaid Provider request", they will direct you to the correct office. hugs., things are slow on this end, the ........has now decided to give all cases to the agencies, UGH!!!!!!!!!!!!!1

Specializes in Medical surgical.
You don't find a supervisor - you find the case. In NY they may be advertised in the Pennysaver or Craigslist. For pediatrics it's the parents usually who most likely will be putting the ad in.

hOW ARE your doing, having a hard time finding new cases myself, they are giving the new cases to the agencies.

3M3RN, you don't have to be advanced practice. Minimum requirements for state of Wisconsin is an LPN or RN license. You may want to check out www.prefessionalhomecareproviders.com. They have info on getting certified for Medicaid/Medicare. I am not sure about how to get Medicare certified or if it is even possible from private duty nurses to get Medicare certified. All directions for how to get Wisconsin Medicaid certified were found on www.forwardhealth.gov.wi. I am still in the learning process as well. Sorry I couldn't be of more help.

How has this been for you? any luck with finding information? I am in WI and just am kind of lost in the process

Hello all nurses.

I got NPI number and I will send Medicaid Provider Enrollment Application form within one hour.

Anyone has idea how long takes to get Identification Number?

AND

After I get Identification Number, I can get my case. Am I right?

Thank you:heartbeat

Hello all nurses.

I got NPI number and I will send Medicaid Provider Enrollment Application form within one hour.

Anyone has idea how long takes to get Identification Number?

AND

After I get Identification Number, I can get my case. Am I right?

Thank you:heartbeat

It took me weeks - but I've been reading that someone received the provider number quickly. By the way - you can take a case now - just keep excellent records so you can process the claim correctly when you get your provider number.

Specializes in pediatrics.

Does anyone know if Minnesota does private duty nursing? I know that not all states offer PDN through Medicaid, but I think I had heard somewhere that MN is one of the states that does offer it. Any MN PDN's on here that could help? I have been doing PDN for about 18 months in WI, and have a good friend in MN who is interested. Thanks.

It took me weeks - but I've been reading that someone received the provider number quickly. By the way - you can take a case now - just keep excellent records so you can process the claim correctly when you get your provider number.

:up: Thanks Lisa. Received the number means.. they contact me, right? Since I get the case, 1. where can I get nursing note? 2. Where do I send it to? 3. How can I get my payment? 4. Is there minimum or maximum time limit per day?

Thanks again:redbeathe

Specializes in ICU, travel nurse, home health,med/surg.
Call up the Department of Social Services in your state, ask for the supervisor of the private duty nursing program. How this works is, after you have obtained your NPI # by goggling up emedny.com, fill out the application for private duty nurse. and NPI #(your id with the state), then call that supervisor for your county, and leave your name and availability with her. Give weekly calls. You will be taking care of pts. in THEIR HOMES, one pt, adults in ny = 36.05/hr, Peds. 43-4/hr. You are totally on your own, so experience helps, you work directly/report to MD, a visiting nurse checks the pt. out every 6 mos., GET MALPRACTICE INS., you bill directly to the state, pay your own SS/Taxes, no benefits, get your own health ins., call your own hrs., very flexible with the families UNLESS IT IS A 24HR. CASE THEN, IT WILL BE 12 hr. shifts, etc., 8 hr. if the nurses decide, work as many hrs. as you like, i have been doing it for years. any questions.

Hi Sunrock, Thanks for the info. I am currently a medicaid provider in Ohio, but will be moving to New York city in September, and am in the process of getting my provider # now. Is the $43-44/hr reimbursement for peds cases before or after the 30% enhancement rate? Is it difficult to get reimbursed as an R.N. In the state of New York? I noticed on pg.5 of the N.Y. Private Duty Manual it stated that prior approval should be at the LPN level unless approved by the MD. Finally, have you ever heard of any private duty nurses taking intermittant cases (straight caths, med administration, chronic wound care,etc)? I know these cases must exist, but is the Medicaid reimbursement lucrative? On Ohio, nurses get paid $54.95, for the first hour of any case. So, if you spend 15 minutes straight cathing your patient, you still get the $54.95. I'm sure the reimbursement in Brooklyn (where I'll be moving) must be higher than it is in Cleveland. I can't seem to get a bottom line on this though. Thanks!

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