Business Planning and Support

imelissa1 · Mar 23, 2011

I am shoulder deap in starting my own Wound Consulting business. I have a business plan, web site and education materials. I'm having trouble figuring out how to get paid. I've read on these postings that only a NP can bill Medicare, but, from what I read on Medicare's website, it does not appear the case. My next step is to apply to the various insurance companies and see what happens, but, will I be waisting my time? I am a RN with a Wound Care Certification and 9 years of home care experience. Any ideas on getting paid and/or billing?

tropicalfish · Mar 23, 2011

Hello,

I noticed someone writing about third part reimbursement.

I think that the RN needs to be an Advanced Practice Nurse, but I'm not sure. I worked as an APN with an MD in solo practice. The Accountant worked with me and I saw that both Clinical Nurse Specialists and Nurse Practitioners can be reimbursed for their services by Medicare, private insurance---but that this is through an MD practice only.

(My MD did not take Medicaid, so I don't know about that. She was not making enough money to take Medicaid patients----it would not sustain a start up solo MD practice's expenses.)

I also think that CNS and NP could get third party reimbursement (Medicare, private insurance) when they have their own business, but pay an MD to be their sponsor.

(I agree that this is totally unacceptable, but MDs lobby and spend money to make themselves have all the advantages, much less nursings' history as a Female dominated line of work. I believe this problem will go away as nursing education advances, but especially when nurses UNITE. We are the largest single healthcare provider in the US and if we stick together we could shut the whole problem down.) But back to business.......

I worked for 2 national healthcare insurance companies and at the time no one other than MDs and chiropractors (but very limited amounts of money) could receive third party reimbursement. Others were fighting to have this happen for them. These included acupuncturists (helped by the fact that some anesthesiologist's obtain accupncture training) and they sometimes did get paid, but on an episodic basis.

I did meet once a few years ago at a nursing conference an RN who was doing battle with insurance companies--I don't know what happened with that. But it will take more than one RN. When I worked in case management in national insurance---the nurses trying to get approved for reimbursement were openly laughed at by both the MDs and Senior Management.

I started a company in holistic care and I do private pay---meaning---get out your wallet or your check book or your cashier's check or your credit card and Pay Me. Also, I do not bill for services-----you need an accountant to help you then and I know I cannot afford that now.

Once I make enough money to support my self I will start more substantial amounts of charity/pro bono/free or hugely discounted work.

My feeling is private pay is a better option at this point in history.

Otherwise, you need to look more deeply into how to get insurance to pay------this is a BIG endeavor.

tropicalfish · Mar 23, 2011

Addendum to previous note:

third party reimbursement is not all that it's cracked up to be.

The paper work is Immense. You would need an account service to do it for you, which is why some MDs are even refusing to take Medicare and Medicaid (though will take some private insurance because the patient can simply send the bill to the insurance company to be paid-----but what I've also seen is that the patients must PAY the doctor while waiting for the insurance to pay the doctor.

tropicalfish · Mar 23, 2011

Also, Wound Care is a FABULOUS choice for a business!!!

I wish I were interested in that. But if we were located near one another I would love to do a joint venture with you.

But back to wound care------

Have you thought about doing "Consulting" work with hospitals and clinics??? You get paid a "salary" by the facility. I have met someone doing exactly that!!! (You can still do your own private patients at another site---and have them pay you cash.)

Also, remember the need for Liability Insurance.

And, have you incorporated yet???? It is Essential.

You get great "write offs" on your personal income taxes. Have your clients--whether private patients or consulting facilities pay your business.

I have had a dream of helping nurses start businesses.

I believe it is a way to either supplement your income or become TOTALLY FREE of institutional healthcare---which is my goal.

tropicalfish · Mar 23, 2011

Hello sir1, Staff,

I am glad to see this thread. I hope it grows greatly and fast!! When I saw it I immediately checked it out-----for help for myself.

I hope to learn more from others in the future.

Thank you for starting this thread!!!

imelissa1 · Mar 25, 2011

Wow! What a tremendous source of information you are. I can't thank you enough and I can honestly say your dreams are coming true....you have certainly helped me start my own business.

I live on Cape Cod, Mass. There is one Wound Center that physicians refer to and that's it when it comes to wounds. My hope was to educate the staff of the multple skilled nursing facilities and home care agencies here. I was also hoping to be used to consult on difficult wounds and/or be used to write wound care algorhythms and patient (staff) education materials. Any thoughts on billing by the hour or monthly contract?

I have incorporated, but, have not upgraded my current personal Liability Insurance to one that is more business oriented. I was going to wait until I had an actual contract before I do that. They are usually effective on payment and just looking for a way to save money.

I know that I can more than pay for my services with the money these agencies will save on effective wound treatment. Now, I have to get them to believe. Any advice on getting in the doors? My plan was to use some current contacts, cold calls/emails and walk right in the door. I've also heard of small business owner groups that get together to network. Any other suggestions would be greatly appreciated....

Thank you so much for your help and time tropicalfish!

FNP-CA · Jul 18, 2011

NPs can practice completelyy independently in the MAJORITY of states - this means, NO physician collaboration of any kind required, not even the need to hire yer own doc. See The Nurse Pracitioner journal's annual survey of states re. NP practice - eye-opening.

Nurs4NursIntl · Sep 22, 2011

This is a wonderful thread:)...I am impressed by the possibility for each of you and heartened to hear of your adventures into business and of the thoughtful advice. I am intrigued that many of the business models discussed here are based on the medical model - which I guess makes sense as that is where HC $ flows. What I wonder is - if we could set aside any notions of limitations - what HC businesses do Americans need that have not been implemented on a broad scale because we have limited our thinking to the medical model - and a little with CAP (really an alternative version of the medical model)? A 'Google' search of 'nurse entrepreneur' reveals legal consultants and a few speakers/trainers. As we continue the journey of HC reform, what gaps do you think nurses can fill that we have historically deferred?