idependent nursing

Nurses Entrepreneurs


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2,719 Posts

Thanks, I guessesed that much. But is she a Nurse Practioner ?(NP) or some other type of Advance Practice Nurse (APN). If not how is it she bills directly?

I know of a Diabetic educator in town who is an RN without being an (APN) she bills certain agencies such as the county and VA. Home health agencies who bill directly, but it was my understanding that an RN could not bill directly on her own without being an APN, or without owning a Home Health Agency. It is my understanding that I cannot do homecare or private duty on my own and expect to be able to bill directly. (or anything else for that matter, except diabetic educator)

I also understood that an RN cannot call herself a Health Care Provider. Unless she is an APN. This was reserved for Physicians, Chiropractors, NP, PA, etc.

I am not being aruementative. I WANT to understand this. It is very important to know that we can bill direct. ANd I need to learn how to do this.

I simply cannot stay in the employee mode. Too stressful.

Help please.


138 Posts

I have been an independent nurse provider (INP) for Medi-Cal (California's Medicaid program) since March 2002. You need only an RN license in CA - this is a new program which allows LVNs and RNs to be independent providers with the EPSDT and HBCS programs.

I have written a short document on how to set about this in CA, but do not want to post my email address openly to get this to anyone interested. Moderator: Please can you facilitate this transfer of info - I'd be willing to post my small file for access thru this site.

Basically identifying a client is the hardest step. Try the Regional Centers (who also have work for nurses, but lower pay than Medi-Cal). However there are many underserved clients out there - especially in pediatrics - so keep trying. I know the first contact person at Sacramento Medi-Cal, but to keep her from being swamped with 'just interested' enquiries, she asked that RNs understand the first step is to find a client.

After that approach you nearest Medi-Cal office (or get my contact's name thru this site with moderator help?) - a Nurse Evaluator is who you need, although not all work with this program. This is the person who helps you get approved - the Treatment Authorization Request process and the Enrollment process run concurrently.

Billing has to be perfect or it will be denied. Turnaround from billing to pay check in my mail box is 3 weeks, much, much longer at the beginning if you make any mistakes. But the system is working for me (and one other RN I recruited). Also there are case management opportunities for RNs (at $35.77 per hour) to assist LVNs with CM who are running their own cases otherwise. INPs are paid at $31.94 thru Medi-Cal.

Hope this helps. I have loads of info., but not sure how to get this to those interested.


2,719 Posts

Thank you JNJ.

Here is how to get a private message to an individual on this board without having to reveal your email address at all. At the bottom of the individual's post you will see a button labled PM. Click on that and you can write a private message (PM) to that person. This board then notifies the individual via regular email that they have a private message waiting. The person clicks on the thread provided in the email message which takes them directly to the private message.

Your email address never has to be revealed to the individual unless you give it to them in the body of your message.

Now I notice that you do not have a pm key at the the bottom of your post. I am not sure what you have to do to put it there but I think you have to modify something in your profile.

I believe that would mean going to the very top of this thread and click on the button "user cp" I think this would allow you to make the modification in your profile to accept PMs.

If anyone has any more specific instructions please assist JJ. Thanks.

By the way JJ I am in NV however I do have contacts in CA. Specifically Sacramento area. It is 180 mile drive for me 3 hours under the best driving conditions. It is not without question that I would consider working in CA. But of course I would prefer to stay home. Either way this is very exciting news. NV tends to follow CAs lead in many legislative things thanks..

nightingale, RN

2,404 Posts

How exciting!

I just worked a 12 and had a glass of wine so my brain cells are not synapsing as well as they will later. Please give me a few days and we will figures something out.

YOU are welcome, any and all individuals to PM me and I will gladly forward, PM, and email this info to others. As long as we are not pulling others to other BB I am sure Brian of AllNurses will not mind us doing it. As for making it available here I am not synapsing well on that thought so I will get back with you.

This is exciting information for many of us.


The Moderator


222 Posts

This is an interesting website RE: Medicaid Home and Community Service. It all seems so complicated though.


258 Posts

Thanks for the advice..I am trying to look into it in my spare time...TYTYTY!!!!


138 Posts

Thanks Agnus:

I am working on your info re: PMs. I also have hard copy info from the internet (obtained after I started my Medi-Cal INP work) from:

If this address is not exact, you are looking for "Credentialing of Indpendent Nurses under EPSDT" first posted in April of 2002 on the Partnership HealthPlan of CA Policy/Procedure docs, plus the attachments and "EPSDT Supplemental Nursing Services" and attachments. I knew what I was looking for, but have found these sites difficult to negotiate.

Also the written info. makes it sound much harder than it really is. They list the many docs. to be provided, but I was only asked for one or two of these.

Thank you all for the wonderful information. As a 38 year LPN and having worked in the field of almost everything, I am always looking around the corner for a leg up for independent work. I contracted myself years ago when no-one else was doing it. The hardest thing was to find the three million dollar insurance and the money I had to come up with for the insurance. Then I went the easy way and worked for a temp nursing company. Never had time to sleep. I started to feel like a piece of meat to fill in where they need ed me. My family loved the money I earned and they all had everthing. I became very tired and was very happy to settledown with a hospital job. I now again want the independence again. Thank you all for your wonderful info. Your all angels.


138 Posts


You've got to explore this independent option again. If CA Medi-Cal is approving LVNs as independent nurse providers, your state can't be far behind.

I've been an INP since March 2002 and love every minute of being a nurse all over again - a 30 yr. veteran. Like you, I was independent a few times in the past too. seemed to get sucked in too often by a nurse teaching position or something that sounded like new technology etc.

I've recruited two other RNs to my field in CA; each is having a good experience. The documentation is not difficult, just a little tedious. Just go thru the hoops, one at a time and make an ally of your Nurse Evaluator person at the state office. Most of them are struggling with these new programs too. Help them to help you. Texas even has their forms on line. I had to teach the CA Medi-Cal Nurse Evaluator how to attach a file to an email, but they're doing well now!

Good Luck and power to you.

nightingale, RN

2,404 Posts

What is being spoken of here, is EXACTLY the reason and benefit I had hoped for this forum.

Thank you.. thank you... posters!


214 Posts

Greetings, All;

My services are paid for under my State's Home and Community Based Services program. These services are funded through a Federal/State funding program. My business is classified as a Community Service business.

I am sub-contracted to provide foot care as a Private Duty Nursing Service- (note: NOT AGENCY.) I bid my services to them each year. Because of the type of nursing I do, there are as yet, no competition bids. My referrals come through the Case Managers (RNs) who have assessed the needs of clients who meet the criteria for this Waiver Program. The majority of those referred to me are diabetics. I use the billing form the Waiver agency provides. I send my billing directly to the agency office. They in turn pay my fees out of the Medicaid fund used for this purpose. I am paid once a month. I am audited by the State on an average of every three years. They have a set criteria of what they want each community service and agency to adhere to regarding the contract agreement. In my case it is nursing notes, office protocols with emphasis on confidentiality, etc.

Because of Federal cutbacks to State Medicaid programs, we have seen some decrease in the number of visits (unit hours) which some community services provide. For example, nursing agencies have had to cut back on the number of times an aide could come in to provide a bath; or eliminated services in the home such as housekeeping. Maintainence services as well as Transport services have been cut back. Offen times these are the high bid areas which Medicaid cannot support now.

I say that when there is an independent agent, (nurse), who is able to UNDERBID the others, then that agent will have more sub contract work than he/she can handle.

Agencies cannot charge their fees and expect full reimbursement from Medicaid these days. They cannot lower their bidding fees because they cannot operate on a deficit. This is where Entrepreneural Nursing comes in. We can work for less and still make money and not just with Medicaid...

... Medicare will also be taking a long look at the Entrepreneural Nurse especially in the area of Private Duty. I think there will be some changes made in the issue of who can bill directly and who can't. I also think physicians are going to take a look at us. Because of the high cost of skilled nursing care in home, Medicare pulls out often long before the patient is ready to be discharged. The Entrepreneural nurse fills in the gaps. This is workable because the self employed nurse does not have to charge the fees- per visit/per type of visit- that an Agency charges.

I might be all wet with some of the above, but I feel very strongly that the day is fast approaching when the need for the independent nurse will be necessary...and I believe that NOW is the time for all nurses who dream of being self employed to get themselves started--no matter how small a venture it may seem at first.

This particular forum is here for those of us who are setting out to do something that smacks against the 'norm' of nursing as a profession and as a practice. Whether we are working directly with the community at large or behind the scenes, the idea of being self employed, self sustaining and self supportive is the ideal that motiviates us. Not all nurses want to be self employed, but ALL NURSES MAY BE SELF EMPLOYED.


Lois Jean

nightingale, RN

2,404 Posts

AMEN... & ditto....

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