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Does your agency staff private insurance cases before Medicaid cases regardless of acuity?

Posted

Has 7 years experience.

For some reason,that strikes me as unfair and maybe unethical.

For example,my agency wanted to send me to work with a kid who has private insurance.

This kid has no trach, gtube, and is only on Bipap.

The kid also has no meds that we give either.

He is also on seizure precautions.

My agency tries their hardest to staff this case EVERY weekend.

Meanwhile,the case i am a regular on is a Medicaid only case.

She has a NGT,trach,and a vent.

I noticed that my agency does not staff her like they should.

She has the weekends where they send no nurse to her.

She was complaining that she thinks the agency does not really look for a nurse for her either.

She is extremely nice,and i do not think its anything on her part.

Why are agencies allowed to do this?

Is it true agencies get paid by Medicaid whether a nurse is there or not?

I know with private insurance,if no nurses work that shift,the agency gets paid.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

No agencies don't get paid by Medicaid if the shift is not staffed. Field nurses are not told insurance status of a patient. It's irrelevant to our care. However this may make more sense--private insurance reimburses at a significantly higher rate than Medicaid. Often 2-3x what Medicaid pays hence why many physicians (and facilities) do not participate in Medicaid. It should be noted that private insurance has significantly more restrictions on length of service for private duty home care nursing than Medicaid. Those requiring long term 1:1 nursing will eventually run out of private duty nursing benefits with commercial insurance and have to revert to the state Medicaid system.

Your patient/patient's caregiver should consider switching or getting a second agency to endure full coverage

smartnurse1982

Has 7 years experience.

Many agencies do tell because your hourly pay is based on insurance of the pt.

The nurses on Medicaid always got lower pay than the private insured ones.

IMO its still unfair that agencies can staff private insured pts before Medicaid insured patients.

You have the opportunity to start your own agency and do anything from only accepting Medicaid, to prioritizing Medicaid patients to staffing based on acuity. When you start your own company these are your decisions.

If you decide to go this route make sure you are very well capitalized because making a business model on Medicaid doesn't often turn out so well.

I often noticed that my agencies that staffed both medicaid and private insurance cases seemed to show preference to the private insurance cases. The internal staff would even make comments that closely alluded to this preferential treatment. Since I have always been treated better by the non-medicaid client families, I sense that my preferences tended to align with the clients that did not seem to need so much "pity". I would guess that clients that don't modulate their behavior better would tend to have more trouble being staffed, but that is only one component of the problem. The patient should not have to suffer because the agency refuses to pay staff a better rate, using medicaid reimbursement rates as an excuse.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

Many agencies do tell because your hourly pay is based on insurance of the pt.

The nurses on Medicaid always got lower pay than the private insured ones.

IMO its still unfair that agencies can staff private insured pts before Medicaid insured patients.

Well there's your problem. Your agency probably has an easier time filling the cases for privately insured patients since the pay is higher, which is why the first case is fully staffed while the other one isn't. How do you know what kind of efforts the office staff is making to fill the cases?

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

Well there's your problem. Your agency probably has an easier time filling the cases for privately insured patients since the pay is higher, which is why the first case is fully staffed while the other one isn't. How do you know what kind of efforts the office staff is making to fill the cases?

Both agencies I work for pay the same rate regardless of payer. Therefore field staff do not know which patients are private and which are state insurance. The only differentials are nights, weekends, high tech/complex team and the last minute coverage team (highest rate paid for skilled experienced nurses who can open a case or cover a call out with a couple hours notice)

smartnurse1982

Has 7 years experience.

Well there's your problem. Your agency probably has an easier time filling the cases for privately insured patients since the pay is higher, which is why the first case is fully staffed while the other one isn't. How do you know what kind of efforts the office staff is making to fill the cases?

I think it is punishing poor people in a way.

My agency has email notifications of openings that are posted everyday.

The same cases always have openings,and its usually 2 groups:

Medicaid pts

The hard to please families.

When i try to look for extra shifts the office staff push me toward the private insurance clients.

I notice if a client that is private insurance with only a gt and a client with a vent,trach and gt that is Medicaid the office staff would still try to staff the private pay first even though a gt is basic.

Edited by smartnurse1982

smartnurse1982

Has 7 years experience.

You have the opportunity to start your own agency and do anything from only accepting Medicaid, to prioritizing Medicaid patients to staffing based on acuity. When you start your own company these are your decisions.

If you decide to go this route make sure you are very well capitalized because making a business model on Medicaid doesn't often turn out so well.

What was your purpose for posting this?

I think some of the agencies are punishing poor clients by doing this.

smartnurse1982

Has 7 years experience.

I often noticed that my agencies that staffed both medicaid and private insurance cases seemed to show preference to the private insurance cases. I would guess that clients that don't modulate their behavior better would tend to have more trouble being staffed, but that is only one component of the problem. The patient should not have to suffer because the agency refuses to pay staff a better rate, using medicaid reimbursement rates as an excuse.

The private insurance clients that are difficult to work with get staffed better than the nice families on Medicaid.

Often,Medicaid clients do live in dangerous areas,so that could be a factor i suppose.

amoLucia

Specializes in LTC.

The private insurance clients that are difficult to work with get staffed better than the nice families on Medicaid.

Often,Medicaid clients do live in dangerous areas,so that could be a factor i suppose.

I wonder if the speed in which agencies are reimbursed by pvt insurance versus Medicaid is significantly different?

The wheels of government move slooowly whereas pvt insurance may reimburse more quickly. If your operating budget is dependent on quick reimbursement, I could see the preference for pvt insurance.

I also wonder if there is additional rules & regs with paperwork that would make the Medicaid clients less desirable. After all, why do more work for less reimbursement if you have a choice?

Just thinking out loud ...

Right now my case is the exact opposite. It's a private insurance but the family is terrible. They have been trying to find a nurse since January to fill the spot. Everyone that's been here is told by the parents not to come. They do a meet and greet and the parents don't like the car the nurse drives. Or the nurse had a crooked tooth. The last one had told them that her last case child passed away. The parents said then you will probably kill our baby too. do the Company told me in private that they are not actively looking for a nurse to fill the spot. Honestly, there are many nights I want to just vent about these private insurance parents.

Edited by Nibbles1
tired

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

I think it is punishing poor people in a way.

My agency has email notifications of openings that are posted everyday.

The same cases always have openings,and its usually 2 groups:

Medicaid pts

The hard to please families.

When i try to look for extra shifts the office staff push me toward the private insurance clients.

I notice if a client that is private insurance with only a gt and a client with a vent,trach and gt that is Medicaid the office staff would still try to staff the private pay first even though a gt is basic.

Maybe because more nurses are credentialed in basic care than trach/vent so therefore easier to staff? Only 25% or less nurses in my one agency are trained, competent and willing to work trach/vent. My other agency 3 out of 65 nurses are trained and competent in trach vent. Or trach vent cases are overnights and fewer nurses are willing to work overnights and weekends. Most prefer days or evenings

smartnurse1982

Has 7 years experience.

Maybe because more nurses are credentialed in basic care than trach/vent so therefore easier to staff? Only 25% or less nurses in my one agency are trained, competent and willing to work trach/vent. My other agency 3 out of 65 nurses are trained and competent in trach vent. Or trach vent cases are overnights and fewer nurses are willing to work overnights and weekends. Most prefer days or evenings

I am vent certified and my agency still tries to send me to the private insurance,basic care client.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

I am vent certified and my agency still tries to send me to the private insurance,basic care client.

You are missing my point. It's likely a combo of staffing levels plus agencies receive a significantly higher reimbursement rate and faster payment processing from private insurance than they do from Medicaid. Faster payment = funds available for payroll and operating expenses and in turn, you have a job. It's an intelligent business decision. Medicaid can take 3-6 months to process a payment, even up to a year. Private insurance is fined heavily if proper payment is not received within 60 days of service, presuming billing was submitted timely & accurately.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

But again my agency (and my second agency) pays the same rate for all cases based upon the level of license, credentials, and experience. Nurses make different rates based upon license, credentials, experience but not based upon client insurance carrier. Field staff have no way of knowing if a client is Medicaid, Medicaid HMO or private commercial insurance unless a family disclosed. Clinical managers and client service managers know because they must submit certifications and request authorizations. It's a need to know and prevents scenarios like you are struggling with now.

smartnurse1982

Has 7 years experience.

Now that i did not know......

brillohead, ADN, RN

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty. Has 5 years experience.

I work for an agency that only does Medicaid and an agency that only does private insurance. Pay is $20/hour for the first one and $30/hour for the second agency.

If an agency can only bill $40 for one case or can bill $80 for another one, which one do you think they're going to choose to staff?

Plain and simple, they are a business, not a charity. The purpose is to make money, not lose money.....