RN Insurance Reimbursement Question

[Phi Gam]

Hello,

I am an RN with a question some of you might be able to answer. I am looking to provide some services, within a nurse's scope of practice, outside the hospital. The problem I am running into is insurance billing. I have recently heard that an RN can bill insurance with a physician's billing # if they have a collaborative agreement with that physician. Does anyone know if this is true and/or how this works? Thanks.

PG

[nurseprnRN, BSN, RN]

The short answer is that it depends on what entity you're billing. If it's Medicare or Medicaid (whatever that is called in your area) you must meet certain conditions. Example: VNAs provide nursing care, and they have requirements for continuing ed, background checks, licensure, insurance, and bonding if they want to bill Medicare. They do not affiliate c a physician practice to bill under the practice to do this. If you can jump those hoops, that may make it easier to get reimbursement agreements from private insurers too. May. You will, of course, have to set up as a business with your state.

If you are looking to bill private insurance (the HMOs/PPOs/etc of this world) your best bet is to contact them directly and ask for their requirements. It may or may not be that nursing care without physician prescription is covered by some or any of their plans. The VNAs can and will provide and bill for nursing care on a private-pay basis without physician prescription. But generally if insurance is involved, the insurance provider wants to know that a physician is prescribing it so people don't just start sending bills for nursing care willy-nilly. See what you can find out from the plans that may cover the patients you intend to see in your area. See if you can get MD prescription for nursing services from your patients' PCPs if needed.

You might also consider going to the Nurse Entrepreneurship forum on AN and ask there. You'll get answers from nurses in a variety of settings.