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    1. Pingback: Medical Forms | Clinical Forms
    2. Pingback: Clinical Forms | Clinical Forms

    3. Hi Barbara,

      I would like it if you post something on HouseCalls. I have learned as I go along, and my housecalls are still in the infancy stage. However, I find that I really enjoy them. The patients are a lot more comfortable, and they are very appreciative. Key points- If patients have insurance, make sure that you check ahead of time when you negotiate your credentialing contracts with the insurance companies that they will cover housecalls, and under what conditions, ie lack of mobility, age or no transportation. The insurance company may be wary, as the reimbursement rate is slightly higher. However, Medicare will pay for housecalls, but it must be stated in the notes why a home visit was necessary. It is also important to be clear with the insurance companies that you are a provider and this is not to be confused with Home Health.

      In addition, make sure you have your medical bag stocked. If possible having a duplicate to what is in the office helps, so that you do not have to trek things back and forth, or forget something at someone’s home. Key items to have in your “housecall bag” include: thermometer, rapid strep kit, bp cuff, (right size), stethoscope, portable otoscope and opthalmoscope, reference books, including those for prescriptions, prescription pad, soap note paper, hand sanitizer, and pulse oximeter. In addition, alcohol wipes, guaze, and other dressing supplies are helpful. I use a lot of hand sanitizer, and if I want to check a pulse ox, I always clean the patient’s finger off with alcohol or hand sanitizer prior to using my pulse ox. I clean off my stethoscope and other instruments with this or alcohol as well. If the patient is new to you, and you have never seen them in the office, you need to bring the registration, health history and hippa forms for signature. At some point you will need to get a copy of the insurance card. If the patient does not have a copier, they usually do not mind if you take their card, and bring it back after you make a copy. Some providers do not take 3rd party reimbursement. If this is the case, make sure you have brochures that state your fees, and when scheduling a home visit, tell the patient on the phone prior to the appointment what the cost will be, usually based on time spent, so there is no sticker shock after driving out the the home and completing your exam. The more clear the communication, the better the health care experience. I am finding that established not new patients make the best housecall patients. They already trust you, and are more likely to want you in the privacy of their home, and you do not need to worry about copying insurance cards, or bringing new patient paperwork for signatures. All in all it is very rewarding, and although I only have about 4 “regular” housecall patients right now, they get quickly attached to this type of visit as well, and soon you will find that they prefer being at home in their pajamas and quite willing to let you trek around town to their house for their visit. Carla Anderson, FNP

    5. Hi Jennifer,

      Welcome to NPBusiness.

      I don’t have a geriatric superbill. There are several superbills on the web that you can grab and edit it to your practice needs – such as using codes for LTC, assisted living or home visits, or just office visits. The ICD9 codes would most likely be similiar to those seen in internal medicine.

      If anyone has a superbill they’d like to share, please let me know. Perhaps we can set them up to download.

      Barbara

    6. I am a Psychiatric Mental-health NP in private practice (since Oct 2006). Currently I am in the Vanderbilt School of Nursing DNP program. I would like to focus my scholarly project on some aspect of NPs in private practice, specifically in my specialty to start. I would appreciate any information you can provide me on the best way to contact other Psych NPs nationally.
      There have been many challenges along the way to a successful practice and I have learned many lessons. I would love to contribute in some way to our profession.
      Thank you,
      Sandra Brooks, ARNP

    7. Hi Sandra,

      I would try national associations (www.apna.org). Also if you look at the NP sites page on this blog, you will see some psych NPs in private practice.

      Also, please consider visiting us on facebook, there are several psych NPs and other practice owners…you can put a request there as well.

      You can also send me an email (use the contact us box above) with your info, and we will see about getting it into an upcoming issue of ProgressNotes.

      Hope this helps,

      Barbara C Phillips, NP
      http://www.NursePractitionerBusinessOwner.com
      http://www.BarbaraCPhillips.com
      http://www.Facebook.com/NursePractitionerBusiness

    8. I would like to introduce myself and my billing service Liberty Billing, LLC. I have been doing medical billing for about 20 years and the last 12 years have been specifically in mental health. I have worked with many Psychiatric Nurse Practioners and I am very familiar with the WA State WAC’s for Nurse Practioners.

      In 2009, I decided I wanted to… See More open my own billing service so I could provide my clients the highest level of personal one on one service to my clients and their patients. My company is a small company that is focused around what works best for my clients and thier individual needs and I personally handle all provider and patient questions/calls.

      Liberty Billing, LLC does all of the billing from A-Z, as many of my providers do not have any office staff. If a claim is denied as provider write-off, I will do all of the researching as to why a claim has been denied and I will let my client know what needs to be done in order to get the claim paid. We verify insurance benefits which will give you a head-up if the patient has a limited number of sessions per year or a high deductible that needs to be met. I personally review all accounts every 30 days when I run patient statments to see what claims have not been paid by insurance and I call the insurance to see where the claim is at in the process or rebill the claim if necessary. We send you monthly reports that are easy to read so you always know where you accounts are at. We send monthly statements to your patients and all insurance claims are sent out electronically within 24 hours of receipt of charges from the provider.

      If you would like to see more about Liberty Billing, LLC and the services I provide please visit my website at http://www.libertybillingllc.com or feel free to call me anytime at 425-218-1944 or email me at lisa@libertybillingllc.com. and I am always happy to provide references.

      Lisa Schmidt-Henderson, Owner

    9. Pingback: Urinary Incontinence Practice? | Nurse Practitioners in Business

    10. Hello Barbara and everybody who reads it. I took your start-up business course twice and it was very inspirational, I highly recommend it. Currently, I am marketing my company’s primary care services to skilled nursing facilities. My company called On Demand Primary Care & Nursing, Inc. The nursing home administrator is wanting to speak to NP’s or those who know of precedents when NP contract with nursing home directly. Please contact me if you know of such NP’s or if anybody can volunteer to speak to this administrator. My phone number 415-407-1286. Thank you.

    11. Hi Barbara,
      I would like to know how to go about getting my business featured on the NP video which will be presented at the Orlando conference in 2012.
      thank you!
      Lisa

    12. Hi Barbara,
      I was interested in working for a company that provides home evals for medicare patients. They require you obtain a PTAN to practice as an independent practitioner, if I apply for this will I be required to pay quarterly taxes on my earnings? If this is true would it be worth the 75 dlrs they provide for each eval. I dont want to owe alot of money in taxes.
      Thanks Dawn

    13. Happy New Year Dawn,

      As an independent contractor you are indeed your own business, and yes, you would pay taxes. Instead of someone witholding it for you, you will have to pay it yourself (plus the full medicare tax – as an employee you pay 1/2 of that now, your employer pays the other half). The benefit to being your own business is that you would then have tax deductions you don’t currently have. To explore this further, talk with your tax accountant.

      In terms of what they will pay you…it all depends on Medicare reimbursement and what you negotiate with this company. You can download Medicare reimbursement fees for your location by visiting your local Medicare carrier or CMS.gov.

      Barbara

    14. Do have any info on Aesthetic training for NP’s in the Southeastern Wisconsin area or Chicago area? Having trouble finding any classes online.

    17. Hello barbara,,im a houston tx housecall np(self employed)if i drop/cancel my current outside billing service today & switch to ally/practice mate(clearinghouse)..,,will i have 2 to 3 month lapse in medicare reinbursments..? or only 1 to 2 weeks..?..thanks much..bp

    18. Hi BP,

      No, you should not have that kind of lapse in payment. (I never noticed that much of a delay). You’ll want to contact OfficeAlly and ask them what you need to do to make the changes, which generally takes just a week or so. Once Medicare had made the billing/payment change on their end, you should be fine.

      Best wishes!

      Barbara

    19. I just started my own business providing care to patients in long term care. One facility has offered to compensate me to cover evening/night call for the MD’s who are the attendings for most of their patients. Any thoughts on an appropriate hourly rate? I used to get $15/ hour to be on call for cath lab as an RN, does that sound appropriate?

    22. Hi Laura,

      The rate for an RN should be different than the rate for an NP. Take into consideration that in most call for LTC (in my experience) is generally fairly busy. Yes, there may be nights that you’ll have just a few calls, but many nights you’ll have far more. Rates often vary based on location. You’ll want to check with your local colleagues to see how they have set up compensation in order to get ranges appropriate for you area. However, I will tell you, that $15/hr sounds low to me.

      Best wishes and let us know how it goes.

      Barbara

    23. Hi Barbara,

      I am a license physician in Florida. I want to make myself available to supervise/collaborate nurses for their practice. Is there a place where I can post for nurses or PAs to see?

      drdonpham@gmail.com

    25. Would you please help me reach more providers for my survey? It is a research study exploring the roles and functions of APRNs who have earned/are in the process of earning/are considering the DNP degree. This survey is designed to understand APRN/DNP contributions to patient care. If individuals choose to participate in this brief survey, they will be asked to answer questions about themselves, their practice and the patients they treat. The survey will take approximately 15 minutes to complete. Answers will be used to inform certification boards and educational programs about the current clinical practice of APRN/DNPs.

      Participation is voluntary. Answers are confidential and only aggregate data will be shared. If individuals choose not to participate, they may do so at any time during the survey. All information will be stored on a password-protected computer until the study is complete, and then erased. If you have any questions about the survey, please contact mcarter@uthsc.edu or at2898@cumc.columbia.edu.

      The survey can be accessed at any time at the following link:

      https://www.surveymonkey.com/r/DNPClinicalPractice

      Thank you for your consideration,
      Amy Rose Taylor, MSN, BSN, RN
      DNP Student

    26. Hi
      Barbara. I am a NP of 3 years, practicing nursing for over 10 year. I have always have an entrepreneur mind and always want to start something that will feel will be a good service within the community. I have started a NP on call service but it hasnt taken route as much as i would desire. I am having some challenges with marketting and getting out their. Now I am wondering if I need something new to begin. I would like some leads and support to move ahead.. What do you suggest.

    27. Do you know of any affordable NP programs in the Chicago area? I am looking at on-line courses also, but do not know if I will save any money with them, and do not want a degree employers won’t value as much. Thanks you for creating this website! It’s given me encouragement to continue to explore getting my NP.

    29. Hi Im intersted in starting a transitional care company. Wondering if any of the readers are business owners in this sector that can offer some advice and or mentorship.

    30. My name is Alyssa Rowe. I am a nurse practitioner starting my own practice called Mobile Aesthetics, LLC, in Bradenton, Florida. I would like to provide high quality, safe, and effective injections, including neuromodulators and fillers, using quality products obtained directly from suppliers, to clients in their homes. My vision is to replace the current in-home injections that are being done with questionable products obtained by 3rd party suppliers, by untrained providers. However, I am having trouble with the suppliers. Although Florida does not require any licensing for injections of neuromodulators, I am finding that the suppliers are requiring a physician for account set up and purchasing. Some even go as far as to require that the office address be the physician’s and that the physician accept liability. My attorney has confirmed that although Florida requires a collaborative physician relationship for me to prescribe under my NP license, that does not apply to my side business because there are no licensing requirements for aesthetic injections in the State of Florida. This has been confirmed with the Florida Board of Medicine, Florida Board of Nursing, and the Department of Business and Professional Regulation. It appears that anyone can obtain questionable product from a 3rd party and inject it legally, but because I, as a nurse practitioner, prefer to do it ethically, I can not. Not because of law, but because of supplier policy. How does this make any sense? I am curious to learn if you have any information or experience that might be helpful in this regard.

    31. Do you have a policy for nurse practitioners that own a practice and how much does it cost?

    32. Victoria, can you clarify your question, I’m not sure I understand? If you are looking for an insurance policy…the answer is no, we are not insurance brokers. What kind of policy are you looking for? Thanks.

    33. Obviously frustrating Alyssa. Without knowing all the details, my first inclination would be to talk with everyone in the company and find out why they are turning away business. There are so many NPs that are doing this work in Florida, I’m somewhat surprised you have run into this (though not shocked). There is a lot of education that needs to happen with these companies. Good luck.

    34. Hello,
      I’m a Family Nurse Practitioner and I currently work in primary care. In my prior career I owned my own business. I would love to become a entrepreneur again but I’m lost. I don’t know where to start or what to do. As I read different articles I see different opportunities such as aesthetic nursing or a house call business. However, I enjoy education. I considered opening a school or possible a case management business. Either one I’m just confused. What other opportunities are out there for NP’s. I live in Florida so most businesses I would need a collaborating physician which is a huge road block sometimes.

    35. Hi Stephanie, there are plenty of opportunities for NPs when it comes to starting and growing a business. You have a deep and wide variety of skills and knowledge that can be utilized. You mentioned you enjoy education. You can provide educational services on a wide variety of topics. All nurses, nurse practitioners and other healthcare clinicians need ongoing clinical education. But they also need to learn new ways of doing what they love to do. What about educating healthcare consumers, caregivers, students, workers.

      I suggest you do a bit of brainstorming and find out what is it that makes your heart sing when you think about owning your own business.\? What is it you would do even if you would not get paid? And can you design a business around it where you would get paid?

      Thanks for this question. Let me know what you come up with.

    36. Hello Barbara,
      I first want to thank you for the pearls of wisdom you are sharing on this forum. I am currently a FNP student and reside in Nevada where we have full ability for independent practice. My goal while I am in school is to develop a plan for my own business so that I am ready to get the ball rolling after I am licensed. My passion is patient education and training. My dream at this moment would be to host educational classes for patients with topics on specific disease processes. Patients would be able to bring in their questions, medication lists, symptoms and diagnosis to receive a more detailed understanding of what is going on with them. Many times there is not enough time in a PCP visit to get this detailed on a specific diagnosis and I would like to provide this for them. I would like it to be a referral process for my services. My question is whether this is a billable service. Essentially I am providing education to the patient and family. Any information would be appreciated. Thank you.

    37. Hi Cheryl, this is a great question and is often asked. However, to my knowledge at the current time, this is not billable per-se. Some of what you are talking about can be re-couped if one is billing for Chronic Care Management, and again, not all payers pay for CCM. While many NPs have identified this as a need, in general, it would have to be a private/direct pay reimbursement model. Hope this helps.

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