Specializes in Complex pedi to LTC/SA & now a manager.
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
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.
Specializes in Complex pedi to LTC/SA & now a manager.
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.
Specializes in Complex pedi to LTC/SA & now a manager.
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.
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
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.....
My agency pays us more if a pt has private ins. But they don't volunteer that info. They tell nurses they don't pay more even though they are reimbursed more. Truth is, they do pay more once they know they can't get over on the nurse anymore about it. I get more for private ins cases. And they do push for those to be staffed more than the others. They make more and get paid quicker.
Agencies that I have worked for have always included the payor source on the 485. However, they have a tendency to tell different nurses different stories about how they choose to pay the nurses working on the case, regardless of the reimbursement source. One nurse will be told that all LVNs or RNs are paid the same hourly rate, while another nurse on the same case will be told that RNs are paid more, or people with 28 years of experience and a PhD are paid more or even a nurse with a twinkle in her left eye rather than her right eye will be paid less. When nurses compare notes, as they are inclined to do, somebody always gets a sour feeling in their stomach when they find that they were told an untruth versus how the other nurses are being paid.
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
I think i could understand this better if the agencies were actually passing some of this money to us.
But they are not...its used for fancy office chairs and other non-essentials.
Around here, agencies pay the nurses based on the payor rate -- I make $30/hour on my car insurance cases and $20/hour on my Medicaid cases. So that money is being passed along, to some extent.
The agency i am complaining about told us we have to buy our own composition notebooks now.
Not sure I understand this... are you using composition notebooks for documentation? If so, it's a requirement of the job and the agency's responsibility to provide it, just like gloves.
Not sure I understand this... are you using composition notebooks for documentation? If so, it's a requirement of the job and the agency's responsibility to provide it, just like gloves.
We use composition notebooks to pass along information that cannot be added to our regular nurses notes.
For example,equipment cleaning or Physician appointments.
Also,most of us just write a quick summary of the shift's events.
Many nurses do not like to read the copies of the nurse's notes,so this works out a little better.
JustBeachyNurse, LPN
13,957 Posts
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