Become Medicaid/Medicare provider

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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.
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!
********currently it seems that the sup. retired and the current one is now giving all of the cases to the agencies, and that is how i am working presently, the rate is very low 28 for adults, and 4 for children, regarding the increase, i am not sure, just ran across your posting, have you moved to brooklyn yet, let me know.
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Specializes in ICU, travel nurse, home health,med/surg.

Sunrock, I am still in Cleveland. Will be moving to Brooklyn in September. I recieved my Medicaid provider # last week but have not started advertising yet. Still confused regarding the payrate. Is that $40 for kids working through an agency? Was the $43-44/hr as independant after the 30% incentive for medically fragile kids? What about the pay for intermittant visits as independant provider? What agency do you work for?

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Specializes in Medical surgical.
Sunrock, I am still in Cleveland. Will be moving to Brooklyn in September. I recieved my Medicaid provider # last week but have not started advertising yet. Still confused regarding the payrate. Is that $40 for kids working through an agency? Was the $43-44/hr as independant after the 30% incentive for medically fragile kids? What about the pay for intermittant visits as independant provider? What agency do you work for?
:D Visits are approx with an agency 39/hr for a total of 30 pts/week anything over 30 is 54/hr, someone just told me. i cannot give you the name of the agency due to this forum send me a private email.
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Specializes in ICU, travel nurse, home health,med/surg.

Sunrock, what us your email address?

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Specializes in Medical surgical.
Sunrock, what us your email address?
**I do not know if we are allowed to post email addresses, send me a private reply
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Specializes in ICU, travel nurse, home health,med/surg.

Sunrock, please email me at [email protected]. I am a new user, so am unable to post private responses. Thanks!!

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I'm interested in this but I live in Indiana. Does anybody know where to go in Indiana. And how long doo u have to be a nurse to do private duty? Can LPN's get medicaid/medicare #?

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How or where do u get started in Indiana?

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Specializes in LTC, private duty, ortho/neuro/medsurg.

Great information but I am still confused about the process in Illinois? Any help would be appreciated.

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Guys, I did my first billing last Tuesday. I was wondering how long do I have to usually wait? I heard a couple of weeks :confused:

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I just got my NPI # and live in Florida. I called Medicaid office, they gave me a link and it says PDN Medicaid provider makes $4.60 every quarter hour...that's a little over $18 an hour. Does this seem accurate? Also is it more lucrative to go with insurance companies? If so how do I find these patients? SO MANY QUESTIONS! Lol I would really like to get the ball rolling on this one. Thanks for any advice!!!

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Specializes in Medical surgical.

This is in reference to above posts. I am here in NY, you can contact the dept. of social services, private duty nurses. This dept. will be your nursing supervisor, you will as mentioned above obtain an NPI #, THIS CAN BE OBTAINED AND DONE ON LINE, AT EMEDNY.ORG., 1-800-343-9000, REQUEST IN OR RE MEDICAID PR0VIDER #, DOWNLOAD AND FILL OUT FOR THE NPI# TAKES ABOUT ONE TO 2 WEEKS. nOW WE are going to need to pool and establish a registry, then we will not be able to use this forum, because that would be advertising and not allowed, hope this post is ok brian

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