Can a RN work as a home health nurse without an agency?

[MAS]

I'm currently working for a home health agency as a BSN-RN and my clients are very dissatisfied. The problem is there are no other agencies that service the area we live in. We constantly have problems with staffing, scheduling, and customer service but because of where we live we feel powerless to do much about it.

I work with 4 other nurses and we were complaining about basically doing all the work and wondering why we even need a nursing agency. We do everything from writing our own schedule to providing our own supplies while the agency sits back and gets paid.

We were wondering if it's possible to open our own agency or just bill medicare/medicaid/tricare directly and not bother with an agency at all? Has anyone ever tried this? What were your experiences and how would we get this started? Thanks in advance!

[CharleeFoxtrot, BSN, RN]

Off the top of my head musings. An agency must be accredited to be allowed to bill medicare, etc., not sure that is something feasible for an individual to obtain. Also you must have policies, procedures etc and ideally medical oversight by an MD. Computer charting and billing software and equipment are a few other things that come to mind. Oh, and I'm sure some type of Liability Insurance.

[Elektra6, ASN, BSN, RN]

I think it’s possible to bill direct when providing private duty care. I know a nurse who does this. She has to pay all her taxes and is self employed. I don’t know about skilled visits though.

[Thanksforthedonuts, BSN, RN]

*cough cough*

I would recommend you open up your own agency. Seriously. It’s not easy, nor for the faint of heart, but I personally know of nurses who opened up an agency because of this reason and then sold the business for MILLIONS. I’ve mused over it and looked into the requirements in my state for doing so, it’s difficult but can be done. I would recommend you just start your own with your group if you can.

Otherwise, I’m not sure how you would bill for nursing visits without a business license or billing system and charging etc... you also have some overhead costs so you should Find a way to keep track of those as well.

[NRSKarenRN, BSN, RN]

Medicare does not contract with individual nurses for home health services, so unable to get paid for patients with that payer; upon starting an agency, first 10 Medicare patients care is not paid for either until agency is verified as compliant with meeting Medicare regulations. Most insurers with Medicare Advantage type coverage require one to be medicare/medicaid certified. Under Medicare, you need to provide at least 2 disciplines to clients (eg. Skilled nursing and home health aide; skilled nursing and physical therapy), can use contracted disciplines for services you don't provide: PT, OT, ST, HHA, Nutrition, Medical Social Work.

In addition to Medicare, agency needs to meet your states medicaid requirements along with home health agency regulations --- in PA regs found under department of health website.

Medicare resources:

Home Health Providers | CMS: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/HHAs

Chapter 2 - The Certification Process (PDF) :https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107c02.pdf

State Operations Manual Appendix B - Guidance to Surveyors: Home Health Agencies https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/som107ap_b_hhapdf

CMS lifted it's 5yr moratoria on new home health agencies in certain states effective 2/1/19. https://homehealthcarenews.com/2019/02/cms-lifts-moratoria-on-home-health-after-5-years/

There are companies available to help setup new home health care agencies performing intermittent skilled visits. Biggest issue appears to be working capital for new startup >$ 250,000.

I suggest you join your states home health agency organization/National Association for Home Care & Hospice, home health newsletters: Eli's Home Care Week or Decision Health's Home health line for insider industry news.

Best wishes going forward.

[caliotter3]

If a nurse wants to do true private duty, that is, work for a client while being paid by that client, all they need do is to come to an agreement with the client. Preferably both parties will enter into a written contract. However, if all concerned are looking for a third party to provide the funds, then the proper hoops must be jumped through. The case that I worked that had nurses working through an agency as well as privately with the client, left the agency lock, stock, and barrel. The case left the agency because the main payor, the client's insurance company, took the case away from the agency and paid the nurses directly instead. No more agency. Everyone except the agency happier. Surprisingly though, the nurses were not paid more when the agency middleman was cut out. Their rate of pay did not change at all. The check just came from the insurance company instead of from the agency. And the client still continued to employ the nurses privately because the insurance company was no better at staffing the case than the agencies over the years.

[Silverdragon102, BSN]

Moved to the Home Health discussion forum