I am an independent home health care nurse and have some questions regarding billing private insurances. Can anyone help? I am in need of procedure codes that work...
Sep 10, '06
What state do you live in? Is it even possible for an RN independently to bill for services rendered from an insurance company coding system? I interviewed for a job once that was with someone who had an insurance policy that paid for RN services and was asked by the client to bill her insurance company for services rendered. When I called to find out how to go about doing this they told me that I would have to follow their coding system. Even after I said that I would be glad to do what they wanted ,a rep. told me they would then decide if they were willing to pay. Well I wasn't about to take a chance of getting it wrong and not getting paid for my work. At the present I work though a nursing registry that bills the pt. and pays me direct. It takes away the head aches of having to deal with collections. If I work directly for a family then they pay me direct and save themselves the middle man fee of dealing with the registry. People paying cash can do this easily but if you are dealing with insurance it is different. I basicly get the same hourly wage wether I work for the famiy (direct pay) or I get paid from the registry. The direct pay cases come from word of mouth networking with a group of other nurses. Good luck. It's nice work when you can get it but there are times when it is slow and your income may fall short. Let me know if you know a way to direct bill I would love to understand more about this possibility.
Sep 13, '06
Appreciated reading the comment of Nurseterr7. Seeking info on how to calculate "real" earnings, that is, have been told that pay is a flat per visit rate -- how does that translate to approximating a per hr. rate? I am referring to mental health home care visits which are typically 45-60 min. in duration.
Sep 13, '06
How to calculate "real" earnings.? Good question.. The thing is if you travel then you have to take that into consideration. Travel time, gas, Parking fees , ect. I do visits for a company that pays me 31.00 a visit. Flat fee . I pay my own taxes. I can do about 6 to 8 visits comfortably a day and do a good job. People who try to cram in 9 to 10 visits in a day are headed for either burn out or the loonie bin. I say this because it is very tiering to get in and out of your car that many times in a day. The thing about being an independent is you have some control over your time. I am at the patients home anywhere from 40 minutes to an hour. Sometimes longer if I run into something that I need to call the MD about or whatever. If my day is not to busy I can take the time to sit and really talk to my patients and it can do a world of good for an elderly home bound pt. plus +++, Open cans and jars, Change light bulbs, tighten down loose toilet seats, adjust walkers and bedside commodes.Yea, Just call me nurse fix -it. Just remember you can write off some of your expenses . I suggest a good accountant....
Sep 18, '06
Thanks Nurseterr7, I live in Ohio. The client has both private insurance and medicaid. I was told by one person to bill medicaid and by another to bill through insurance. He needs continuous care nursing for about 9 hours per day. I am so confused, but I want to do the right thing. The insurance company doesn't recognize me as a provider obviously but without codes and provider numbers, they won't give me a real answer about coverage. Any thoughts?
Sep 18, '06
Thanks so much for your reply. I am new to this site and posted in several areas and you are the only
(first?)person who has responded to any of my questions!
Sep 18, '06
You said in your thread that the person has Medicaid ( not Medicare )and private insurance. Maybe I am wrong but usually people with Medicaid are not in a position to have any other kind of insurance. If he has Medicare and private insurance then you would need to find out what his insurance covers as far as skilled nursing services. Did you try calling the insurance company? Bet you didn't get far. If he does have Medicare (not Medicaid) then only an agency with a provider number can send a nurse and then it is only to do a nursing function that is maybe a billable hour or 2 at best . Medicare also may pay for a Home Health Aide for maybe an hour or so to help with ADL's. Or PT,OT Speech Therapist. But the daily visits are only about 1 hour. That is all Medicare will pay for. I could be wrong about this but that is what I remember when working Medicare HH. Private insurance is tricky because they are all so different as to what they will pay and with Health care being what it is in this country it is my personal feeling that they are less than forthcoming with any information that will help you figure out what you or your client is entitled to. If you can find a nursing registry that works with insurance companies and call them then maybe you can work with them (after all you are giving them a referral) and they can bill for you and you can work the job. At least there is a better chance you will get paid. Maybe in Ohio you can get a provider # I don't know? But please let me know how this works out for you.. Smiles
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