Getting Paid for Admissions that are Refused


I had a recent referrals for a SOC. When I arrived at the home (after making the appointment ahead of time on the telephone) the client acts surprised, not really sure why I am there, and does not want home care. I of course explain what home care is about, and that the doctor has ordered this, but that it is their right to refuse service. I also point out that Medicare/Medicaid will pay for these services with no copay. This type of visit takes time to go back and forth, and also my car expenses. In my agency we are only paid "per visit" so if I don't hand in an OASIS because I could not do a start of care, I don't get paid. What do other agencies and home health nurses do in this situation? Should the agency pay an hourly rate including travel time?

tewdles, RN

3,156 Posts

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

You should minimally be paid your mileage and time for a "nonbillable visit". The fact that the patient did not sign on is a problem for the agency but should not be a problem for the professional who was charged with making the visit. You should still be paid for your time.

This recently happened to me...drove 50 minutes (one way) to make a 3 hour visit during which the family asked every question under the sun, brought up every barrier and objection conceivable and ultimately did NOT sign election of benefit paperwork (hospice). They even were already using equipment paid for by the agency and delivered to the home in advance of the patient's discharge home from the hospital.

This was a very expensive case for my agency, but it is a known hazard of the business.


138 Posts

It's nice to know that I should be getting paid. What if my agency refuses?


38,333 Posts

You did not just pick an address out of the blue to visit that day, you were sent by your agency. They should pay you the minimum of what they consider to be "show up" pay. Usually that is two or four hours at the hourly rate. Your agency will probably refuse. None of my agencies have paid me for show up pay recently. They think I am made of money and can go prantzing around the county wasting my time and creating car expenses. On one occasion I actually worked for one hour. I hate to have to make a trip to the Labor Board over this, along with unpaid overtime and holiday pay. That is one reason why I am seeking employment elsewhere.


214 Posts

we recently started getting paid $15.00 plus mileage for those visits! not much, but better than the nothing we have been getting.


51 Posts

Specializes in Home Health,CCM. Has 16 years experience.

If our nurses spend a substantial amount of time in the home, they are paid for a "regular visit" + transportation. If it's just a few minutes or if no one is there, they are paid a "sup visit" rate + transportation cost.

Has 7 years experience.

I am salary, but the "wasted" time does effect my productivity. We get partial credit as determined by clinical manager depending on the amount of time invested, traveled and also reimbursed for mileage. Most of the time it is equitable and fair, rarely if I spend an hour or more and it ends up a no-go, I get the short end. I usually START my admission conversations with a brief qualification conversation to weed out the ones I might otherwise waste time on. Not homebound and not skilled (can sometimes tell from the referral info), quick NOGO.

This occurred just yesterday, actually, where the patient wasn't at the address which was provided to me but a family member answered the door and reported he had driven home that day and gave me the correct address. To which I arrived to find a perfectly ambulatory patient recently discharged from the hospital and referral to HH because PCP was on vacation for another 3 weeks. Spent no more than 20 minutes assessing needs, determining they may be met easily on an outpatient basis and making a call to the on call MD to report need for appropriate referrals. I will probably receive an hour worth of time for this.

You should DEFINITELY be getting paid for this!


385 Posts

Specializes in L&D; GI; Fam Med; Home H; Case mgmt. Has 15 years experience.

I get my regular hourly pay no matter what happens. Why shouldn't you? You are working your job, and your job has a regular rate of pay, right? I can't imagine being told I wouldn't get paid for putting in work. It's not your job if the client ultimately chooses not to start care. You still did your job!


266 Posts

Stay away from agencies with crappy referrals.

Good luck getting paid if you are on a pay per case basis.

Some home care agencies treat nurses like prostitutes. They send you "out in the streets to make money". If the customer doesn't turn out to be profitable for the company, they will throw you out in the street to seek out another customer, etc.