how to become a PDN in california?

Editorial Team / Admin · Dec 18, 2014

Hello,

Welcome to allnurses.com

Good luck with your plans as a Private Duty Nurse. Others will come along and help you.

caliotter3 · Dec 18, 2014

I was told that you need to have a client before you can do all the rigamarole in getting a MediCal independent provider number. Do some research online to see what you can find. I can tell you one thing though, the person who clued me in on that told me she is making big bucks. More than a $10 difference in pay from what the agency, and then the insurance company, were paying her for working on the same case.

Assume that is the type of work you are asking about. If you are asking about straight private duty work, you can find a private party employer by looking on employment websites, such as craigslist. When negotiating working for a private party you should get any agreement in writing in the form of an employment contract in order to protect your interests.

mdflores · Dec 19, 2014

I currently do have a client that I am working with and I work through an agency. However I want to do the PDN because my job won't allow me to work overtime and doesn't pay as well either. The family I work with would like to keep me on the case. I just need help finding out how to become a PDN. I currently applied for a Provider's Identification Number since I was told I need one. But how do I apply for a MediCal number? I was told it was different from the P.I.N. I was also told I have to become incorporated.

caliotter3 · Dec 19, 2014

Have no idea about the incorporated statement. My friend told me that she needed the client to get the provider number. I think that number is one and the same for MediCal. She is getting paid way more than she was being paid when working for the agency. You can always work private duty for a private paying client and don't need anything other than your nursing license, skills, and malpractice insurance for that. If the family is going to go straight through MediCal and get out of the agency runaround, they can give you the contact info so you can start the process (or it sounds as if you already have done that). I did not follow up on it because I don't have a client that wants to leave their agency. My clients always liked to complain about the agencies and talk about moving to another agency, but that was all it was, just talk and complaining. It takes effort to leave agencies altogether and go straight through MediCal.

tnmarie · Dec 19, 2014

Something to keep in mind: most agencies have a non-compete clause. You can not take your current client away from your current agency if you have signed a non-compete clause. It may not be applicable to your situation, but you'll want to make sure. Good luck!

brillohead, ADN, RN · Dec 21, 2014

Another thing to keep in mind -- terminology.

We are *ALL* Private Duty Nurses --- the name has nothing to do with billing or insurance or agency/no agency and simply refers to the fact that we are the sole "private" nurse for one individual patient.

It sounds like you're looking to become an Independent Contractor/Provider providing private duty nursing services to a client directly, without having an agency or boss of any kind. You would handle your own billing to the insurance company, as well as needing to meet any state and insurance requirements as far as documentation / charting / care plans / physician orders / assessments, etc.

You would still be a Private Duty Nurse if you were your own employer versus if you were working for an agency. When you say you're currently working for a client via an agency, you're *already* doing PDN work. What you mean to say is that you want to be an "Independent Provider" or whatever your state's Medicaid office calls it. You're already a Private Duty Nurse.

caliotter3 · Dec 21, 2014

I distinguish private duty, private paying clients, as I was taught in my BSN program and supported by my initial employers. We all know that there are two main types of nursing care that occurs in the home. Because one group chooses to call "extended care", one thing, while another group calls it another, does not change the nature of the work. A private paying customer is still a private paying customer. There is no need to debate the two trains of thought, just make it clear whether or not one is talking about intermittent visit work, or extended care, or, if the situation warrants, a further description that more clearly conveys the idea in discussion.

brillohead, ADN, RN · Dec 21, 2014

I distinguish private duty, private paying clients, as I was taught in my BSN program and supported by my initial employers. We all know that there are two main types of nursing care that occurs in the home. Because one group chooses to call "extended care", one thing, while another group calls it another, does not change the nature of the work. A private paying customer is still a private paying customer. There is no need to debate the two trains of thought, just make it clear whether or not one is talking about intermittent visit work, or extended care, or, if the situation warrants, a further description that more clearly conveys the idea in discussion.

But this entire thread is NOT about a private paying client at all -- it's about being paid by state-funded Medicaid insurance.

That's my point... "independent" is not the same as "private".

There are self-paid, regular/personal-insurance-paid, and public-insurance-paid versions of providing shift care to a patient in their own home. They are all generally considered "private duty nursing".

My nursing program's textbook referred to private duty as being one nurse and one patient, regardless of where the care was being given or who was paying the bill. Some families may choose to pay out-of-pocket for a private nurse for a patient in the hospital or in a nursing home, and that would be considered "private duty" as well, in addition to in-the-home private duty nurses.

I have clients whose payment comes from Medicaid, and I have clients whose payment comes from auto insurance. One of my agencies has a client whose mother's private health insurance pays the bill. In each of those cases, the patient is receiving Private Duty Nursing services, even though the patient's own private bank account isn't writing the check.

When I first saw the subject line for this thread, my immediate response was, "Go to a home health agency and apply! That's how you get a job doing private duty nursing." But that's not what the OP was asking at all... they wanted to know how to become an independent provider for California Medicaid insurance billing purposes.

Also, a heads-up to folks who are going the independent route -- make sure you talk to an accountant or other tax professional. If you're self-employed, in addition to all the liability/insurance ramifications of not having an agency, you're also on the hook for all your own payroll taxes.

Most people don't realize that the FICA that comes out of your withholding is only HALF of what actually gets sent to the IRS -- the employer has to pony up part of the employment taxes, and if there is no employer, the worker is responsible for the full amount. You'll also probably have to make payments to the IRS and your state's treasury department (or whatever your state's version of the IRS is called) at a minimum on a quarterly basis, but possibly even more often than that, depending on your income level. Definitely seek guidance from a tax professional.

You're also probably not entitled to unemployment compensation if you lose your job, because you won't be paying into the system (this may vary from state to state, that's why it's important to check with a tax professional who is familiar with self-employment practices in your area). That's another payment that your employer makes on your behalf that most people don't realize is going on behind the scenes.

And definitely make sure that you have excellent health insurance and disability insurance and Liability Insurance in place -- if you get injured on the job (hurt your back, fall and break a bone, get an infection, etc.), you won't be eligible for Worker's Compensation payments, both to cover the medical expenses and to cover the lost wages until you can work again. (That's yet another expense that the employer covers behind the scenes for the employees.)

All these extra expenses and extra risks are why you get more per hour when paid directly instead of going through an agency -- there are additional costs beyond just your hourly wage rate that will need to be covered. By the time you pay the extra FICA, extra insurances, and CPA bills, you may find that you're not making much more than you were through an agency.

Of course, many people just fly by the seat of their pants and don't bother with the extra health / disability / liability insurances or putting money aside for a rainy day (if your client gets hospitalized or moves away or just decides to change agencies, you no longer have an income!)... some of them are lucky and things go well for them anyway, while others end up in dire financial straits because of their lack of proper planning when things go pear-shaped.

caliotter3 · Dec 22, 2014

Just because the first post was not clear did not mean I could not talk about a private duty client in my reply. I indicated in my second post that her post was not necessarily clear. I know the difference between a private duty client and a client receiving care from an independent provider. I will go with what I was taught about home health by my degreed experts. It has worked for me for decades and will continue to work for me. When I reply to persons in private messages concerning these matters, I point out that there is a difference in the point of view regarding the semantics of home health terms. As long as people understand what is being conveyed, it makes no difference, unless one wants to always be fighting for being considered "right". That does not mean that one has to argue with others to point out that the other point of view is wrong. It is not. I do not do private duty work because I do not care for the atmosphere that goes along with it. Having a third party employer puts me in a position of "maybe" having support on the job. I also stated why I have not pursued independent provider status in my state. OP, feel free to send a PM. Hope that you are able to get the information that you need to do the job.

mdflores · Dec 24, 2014

There really was a lot more to it than I thought. Lot I have to reconsider now since you brought up a lot of good points. Thanks. Very helpful.

brillohead, ADN, RN · Dec 24, 2014

There really was a lot more to it than I thought. Lot I have to reconsider now since you brought up a lot of good points. Thanks. Very helpful.

I hope you don't think I was discouraging you from pursuing this option -- I just want everyone to go into it with their eyes wide open, fully aware of all the legal and financial ramifications.

In my pre-nursing life, I was a bookkeeper, and so I was familiar with things like employer-paid taxes, workers compensation insurance, unemployment compensation, etc. The general public is typically unaware of the behind-the-scenes aspects of employment law / costs... nobody ever really teaches the average worker about these things.

It could very well be that even with the extra expenses, you'll still come out ahead of the game by becoming an independent provider. From one nurse to another, I hope that's the case for you! We're all on the same side here!