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Billing skilled nursing as an independent contractor

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by savebabies savebabies (New) New

Has 3 years experience.

I'm wondering if anyone bills their client's insurance and works as an independent contractor? I've been with my patient for a long time, so I'm not worried about the other requirements of being independent, just the billing. I'm in Massachusetts and would have to get a denial from their private insurance in order to bill Masshealth. Anyone out there that has gone this route?

My former supervisor at a case started getting paid by the insurance company when the case was taken away from the agency. As far as I knew, she never said anything about billing the insurance company. According to her, her paychecks just started coming from the insurance company instead of the agency. The insurance company didn't even raise her pay, seeing as how the agency middleman was removed. I know a nurse who said she plans to take her case away from the agency so that she is paid directly from the payment source (state medicaid). Her plan is to take 100% of the reimbursement rate. Apparently that is possible. It involves going through a vetting process with the state.

savebabies

Has 3 years experience.

Thanks for your reply! That’s interesting. I would assume she lived in a state where you submit your documentation directly to the state or insurance company? We don’t have to submit our notes/assessments in MA unless you’re audited by the state. I’ve obtained my NPI and become an independent provider, It’s just figuring out the insurance companies I am confused about. It sounds like it’s different depending on what state you’re in.

If I recall correctly, my former supervisor may have said that she didn't do documentation for the insurance company like she did for the agency. She just kept a notebook for the parent of the patient with day to day entries. That did not make sense to me. If anything, I would have thought that the insurance company would have required even more detailed documentation than any agency! Too bad I am out of touch with that person or I would try to get more detailed info. It has been very many years since that case for me.

areason4stars, ASN, RN

Specializes in Pediatric Private Duty AND Child/Adolescent Psych. Has 12 years experience.

On 7/23/2020 at 11:51 PM, caliotter3 said:

My former supervisor at a case started getting paid by the insurance company when the case was taken away from the agency. As far as I knew, she never said anything about billing the insurance company. According to her, her paychecks just started coming from the insurance company instead of the agency. The insurance company didn't even raise her pay, seeing as how the agency middleman was removed. I know a nurse who said she plans to take her case away from the agency so that she is paid directly from the payment source (state medicaid). Her plan is to take 100% of the reimbursement rate. Apparently that is possible. It involves going through a vetting process with the state.

Wondering how an agency in this day and age gets away with their nurses not signing a non compete contract. My pediatric private duty agency did, therefore I wasn't able to pursue "taking away" my patient from my agency even tho my patients parents at the time and I had some discussion about me taking the steps necessary to "cut out the middleman(agency)"

As lackadaisical as many agencies are, I can see how nurses get away with it. I have not been forced to sign a non compete agreement in decades. The RN I mentioned did not orchestrate the case leaving the agency. I recall her stating the impetus came from the insurance company itself. She just went along for the ride. The nurses I’ve met who talk about going independent with their cases have all been LVNs. Perhaps a testament to how people react when they find out how low their wages really are.

mber989

Specializes in SNF, Home Health, Detox. Has 4 years experience.

Hi savebabies would it be alright to PM you? I just learned about INP today and I would really like to learn more about it especially first hand account. I'm also in Massachusetts and think that this could be a great opportunity. Thanks!

savebabies

Has 3 years experience.

Yes you can!

mber989

Specializes in SNF, Home Health, Detox. Has 4 years experience.

I'm not sure if I'm doing incorrectly, but I tried clicking on the envelope icon that I thought was for messages but it says that I'm allowed 0 messages per day. I wanted to know what the process of getting set up through Masshealth is like? I was on the site and I started reading through the requirements.

savebabies

Has 3 years experience.

Sorry I just saw this now! It was a few years ago that I did it, but it was pretty easy. I had to register and get an NPI number and do some online modules as well as one that was over the phone while being on the computer, kind of like a zoom meeting but before that was available haha. There was a point person for me to contact if I had any questions who was very helpful, just not when it came to dealing with BCBS. For billing you order a certain billing form and then every shift you work you put the ICD-10 codes according to your patient's diagnosis in that box and the hours you worked. You could bill for up to 5 shifts on 1 form I believe. You're required to keep a chart with your patient's healthcare plan and orders from their doctor. I can't remember the requirements of notes/assessments because I just photocopied the agency's forms so it was easier for the family to read. Good thing, because when I didn't get reimburse I just billed the agency.