Can a NP be a primary care provider and work with other health care providers?

[satyadhi]

If I live in a state that allows NP's to work completely independently of physicians and choose to do home health can I...

1. Have some longterm home health clients whom I will be their primary care provider. They don't have another doctor, I take care of everything. I prescribe and change their medications and make all the decisions between me and the patient.

2. Have some short term home health clients who I am not the primary care provider. I have connections with some local doctors who call me up when they want someone to provide some home health care for their patients. I follow the doctor's orders for the patient and do not change meds unless the doctor gives the ok.

It seems like a nice combination... is it possible? Maybe it is a silly question?

[caliotter3]

Sounds like a reasonable question to me. I've read about independent providers a lot here, but don't recall anybody stating they were a NP. The process to get your provider certifications for medicare and such is tedious from what people have posted in the past. I would think that getting your name out there in competition with the agencies would be a big factor in whether you can make a go of this.

[satyadhi]

I guess there is no way to avoid the boring medicare stuff... I still think I'll like home health though.

I plan to build my client base by working as a primary care provider in an office with several other doctors and NPs. The other docs and NPs will give me their short term home health patients and I'll get my own long term patients from the people I serve as primary care provider who need long term home health. It may take several years before I am able to do home health full time, but I think the journey will be almost as exciting as the destination.

[HmarieD]

I believe in Medicare Home Health Conditions of Participation, it states that the HH Plan of Care (and any subsequent orders) must be signed by a physician or a podiatrist. You can find Medicare HH CoPs on the CMS website (www.cms.hhs.gov)

[satyadhi]

So I guess being a NP does not count even if the state you live in allows Nps to work as primary care providers?

Well that brings me to another question...

Is there any way someone can do home health without using medicare?

If I can become an NP and work independently in a office or clinic then I don't see why I should not be able to make house calls.

[KateRN1]

APRNs cannot sign the 485, you will need to have a physician for that. That is a Medicare law and you cannot get around it, regardless of your state, if you want to take Medicare cases. However, you may look into your state's requirements for MediCAID cases. That is a seriously underserved section of the population that has a hard time obtaining healthcare, especially when homebound.

[satyadhi]

That sounds ok because my heart is with the underserved anyway.

I could still take medicare for my short term home health patients because with the short term patients I will be providing short term home health care for another health care provider's patients.

How would I go about finding out if medicaid allows this? It seems like searching for a needle in a haystack.

Could I just bypass insurance altogether and use a sliding scale instead?

[satyadhi]

What about private insurance for home health?

It seems to me I would want to be able to accept as many different payment methods and insurance as possible.

[HmarieD]

There is a great need for primary care practitioners to do home visits. I think what you may be thinking of would be more like a "doctor's visit" than a skilled nursing visit. If that's the case, I think we are muddying the waters for you here because our frame of reference is doing skilled nursing visits under the umbrella of a Medicare-approved agency, which is a completely different animal.

You might be better off asking these questions of primary care practitioners rather than home health nurses. I hope that you get the answers that will allow you to carry this out - there really is a great need for folks like you! Good luck.

[NRSKarenRN, BSN, RN]

we have 2 such practices in philadelphia --they both need collaborating physician as pa regs require it along with medicare.

see articles

house calls as a practice venture on advance for nurse practitioners

practice snapshot: primary homecare, philadelphia pa

ask the experts - can i set up an independent practice providing house calls?

medscape nursing, free registration required

practices:

primary home care

http://www.advancedclinicalconsultants.com/

housecalls rx

[satyadhi]

So what are some of the differences between what an NP who does home health would do and a NP who works as a primary care provider who does house calls would do?

Could I do a little of both?

[KateRN1]

I would think it might be a little confusing and would not be easy to bill. As a regular RN, you would not be able to bill for your services under Medicare, but would have to realy on the episode payment generated by your HHRG score.

As an NP, you would still need to be practicing under a physician, so s/he would be billing for your services, and you would need to collect payment from the physician. Can NPs bill directly to Medicare for office visits? Not sure on this one as I've never had to deal with it. And your patients would still need to meet homebound criteria for reimbursement.

Either way, you're going to be at a physician's mercy and I can tell you that it wouldn't suit me in the least, but that's just me. Home health is a very physician-centric area of health care.