How much does insurance pay for home nursing services?

[ApolloC, BSN, CNA, RN]

I can't find anything about this online. If anyone who is a home nurse or works for an agency knows please share.

[klone, MSN, RN]

There is no one answer.

[Nascar nurse, ASN, RN]

Agree - no one answer. You need to call the insurance company directly to find the coverage rate

[KrysyRN, BSN]

I agree with the above posters.

Different health insurance plans pay different amounts, and there may be a cap on the number of visits that are covered by the plan each year. It also depends on the home health services that are needed. Generally, most plans do not pay for custodial care (which is typically the work done by a CNA) if that work is not part of an RN care plan. However, most plans do pay for home care that require an RN to perform the care [but only a certain number of visits may be covered - and that number can vary by health plan and whether or not the patient has secondary insurance].

Health plans also require a physician's order for the number of visits, length of time, and reason for the visits in order to determine if home health care is a covered benefit.

I hope this helps.

[ApolloC, BSN, CNA, RN]

The reason I ask the question is that I am in the final semester of my BSN program and I am thinking of a long-term career plan. Eventually, I would like to own my labor and potentially open a visiting nurses agency where I see and bill for all my own clients with no middle man. I want to gather information on that process. Is anyone aware of someone already doing this, if so what are some of the basics involved?

[KelRN215, BSN, RN]

The reason I ask the question is that I am in the final semester of my BSN program and I am thinking of a long-term career plan. Eventually, I would like to own my labor and potentially open a visiting nurses agency where I see and bill for all my own clients with no middle man. I want to gather information on that process. Is anyone aware of someone already doing this, if so what are some of the basics involved?

That sounds unmanageable to do all your own billing and see all your own patients. I think you're underestimating how much work is involved. I don't know of anyone doing this for skilled nursing visits. There is a large population of Medicaid "independent nurses" in my state who bill Medicaid directly for private duty nursing services. (These services have already been authorized by the state.)

Every insurance is different.

When I worked for a home nursing agency, we billed skilled nursing visits at $120/visit. Medicaid reimbursed around $90/visit and some private insurers reimbursed only $63. By being in-network with these insurers, you agree to their rates.

Medicare is a different beast all together. Medicare reimburses a flat rate per 60 day episode vs a fee for service type model.

[KrysyRN, BSN]

You may want to speak with owners of local home health agencies to see if any of them are RNs and if they would be willing to speak with you. You might find a lot of answers to your questions this way.