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CAPC Palliative Care Discussion Forum
Billing and Financial

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Post Extended Services
Author: Laurahodges
Date: Aug 11, 2007 2:52 pm

I recently obtained my MSN after obtaining my MBA/HCM. During a doctor visit with my PCP she encouraged me to look into a pallitive care business where I live. She noted that there was nothing in our area except for hospice. She has gone to training and noted she only gets referrals when the clients are on death's door and hospice services are needed.

I live in Florida for 20 years before moving back to my hometown where I worked private duty for a friend of mine who owned her own private physican agency that provided pallitive care services. Her agency dealt with rich clients that paid cash for RN's and/or Nursing Assistants 24 hours around the clock in home &/or in hospital. I viewed the billing tools and did not see anything for nursing service reimbursment....is this possible? If so can you guide me in the right direction. Thank you!

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+ Re:Extended Services (by lhspragens on 08/14/2007)
First, most of the tools on the website are for inpatient billing, and nursing services are not billed separately, but are included in the DRG/Part A hospital billing. Separate billing is for Part B services - physician/provider services. If you are thinking about private pay options for home based services, then your best comparison points will be info on home health care nursing costs and options in your market. Depending on your market, you may also want to do informational interviews with a local hospice and a home care provider, to see if they are considering doing this and can be partners or referral sources if they do not plan to do this. Also they will have info re both billing and payment rates. You can probably also find much of this on the CMS website. There is considerable interest (not a lot of models or data) in provider home visits for palliative care, so another consideration is whether you are thinking of a "nursing only" service, or a team practice with other providers.
Re:Extended Services (by AmberBJones on 08/14/2007)
The response from Lynn Spragens is excellent. As you point out, patients who have the financial capacity to pay privately for services may do that. Under these circumstances, the Agency would presumably negotiate the rate for services rendered with each patient/family. However, unless the Agency is especially vigilent, it may be difficult to assure the quality of the care. Further, State licensure and certification restrictions may apply - so it would be prudent to understand and comply with those requirements. One additional option is the provision for professional services reimbursement for qualitified/licensed nurse practitioners. The Hospice and Palliative Nurses Association (HPNA) is a good resource on this topic.

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