Nurse Practitioner's Business Practice and Legal Guide

by Buppert, Carolyn

• ISBN13: 9780763731632
• ISBN10: 0763731633
• Format: Hardcover
• Copyright: 2003-04-01
• Publisher: JONES & BARTLETT PUB

Summary

Written by a nurse practitioner who is also a practicing attorney, Nurse Practitioner's Business Practice and Legal Guide, Second Edition provides the unique point of view of an author who knows what legal and business problems arise on a daily basis.

Author Biography

Carolyn Buppert, CRNP, JD: Attorney Annapolis, Maryland

Table of Contents

Preface	p. ix
What is a Nurse Practitioner?	p. 1
Definition of Nurse Practitioner	p. 1
A Nurse Practitioner, By Any Other Name	p. 2
Services Provided by NPs	p. 3
Preparation and License Requirements	p. 5
Initials	p. 6
Areas of Practice	p. 6
Legal History of NPs	p. 6
Demographics	p. 7
NPs in Primary Care	p. 7
NPs' Legal Authority to be Primary Care Providers	p. 9
NP Versus PA: What's the Difference?	p. 10
NP Versus Physician: What's the Difference?	p. 12
NP Versus RN: What's the Difference?	p. 14
NP Versus CNS: What's the Difference?	p. 15
Where Do Nurse Practitioners Practice?	p. 17
State-by-State What is a Nurse Practitioner?	p. 18
State-by-State Titles for Nurse Practitioners	p. 33
Legal Scope of Nurse Practitioner Practice	p. 37
Professional Association Definition of Scope of Practice	p. 37
Statutory Versus Regulatory Scope of NP Practice	p. 38
Physician Challenges to NPs' Scope of Practice	p. 39
Need for Clarity of Scope of Practice	p. 39
NP Scope of Practice Compared with RN Scope of Practice	p. 40
NP and MD Scope of Practice Compared	p. 43
Mandated Physician Involvement with NP Practice	p. 44
State-by-State Law Nurse Practitioner Scope of Practice	p. 47
State-by-State Requirement, if any, of Physician Collaboration	p. 75
State Regulation of Nurse Practitioner Practice	p. 111
How Laws About NP Practice Evolve	p. 111
What is Regulated?	p. 112
Agency That Regulates Nurse Practitioners, State-by-State	p. 114
State-by-State Nurse Practitioner Qualifications Required by Law	p. 117
Federal Regulation of the Nurse Practitioner Profession	p. 135
Medicare	p. 135
Medicaid	p. 139
Nursing Homes	p. 139
In-Office and Hospital Laboratories Under CLIA	p. 140
Self-Referral by Health Care Providers, Under the Stark Acts	p. 140
Prescription of Controlled Substances Under the DEA	p. 142
Reporting to the National Practitioner Data Bank	p. 142
Patient Confidentiality	p. 142
Discrimination in Hiring and Firing	p. 145
People with Disabilities Under the ADA	p. 145
Documentation Guidelines for Evaluation and Management Services	p. 146
Prescribing	p. 183
Controlled Substances	p. 183
Guidelines for Prescribing Legally	p. 186
State-by-State Law Prescriptive Authority	p. 188
Hospital Privileges	p. 227
Are Hospital Privileges an Issue for NPs?	p. 227
Do PCPs Need Hospital Privileges?	p. 228
What if Health Plans Require PCPs to Have Admitting Privileges?	p. 229
Do NPs Need Hospital Privileges for Advancement of the Profession?	p. 229
Do Individual NPs Need Hospital Privileges?	p. 229
Who has Hospital Privileges?	p. 230
Does Federal Law Support Full Hospital Privileges for NPs?	p. 232
What Does it Mean to Have Hospital Privileges?	p. 232
Levels of Privilege	p. 232
The Application Process	p. 233
Expense	p. 233
Denial of Privileges	p. 233
Expect Change	p. 234
Negligence and Malpractice	p. 235
What Can Happen to an NP Who is Sued?	p. 236
Life Cycle of a Lawsuit	p. 236
What is Malpractice?	p. 236
Elements of Malpractice	p. 236
Examples of Lawsuits Against NPs	p. 238
The National Practitioner Data Bank	p. 242
Working with Practice Guidelines	p. 243
How to Prevent Lawsuits	p. 244
What to do if Sued	p. 244
Communication	p. 244
Liability of Collaborating Physicians	p. 244
Malpractice Insurance	p. 246
Risk Management	p. 249
Risk of Making a Clinical Error	p. 249
Risk of Being Sued for Malpractice When There Was No Clinical Error	p. 252
Risk of Public Perception That the Individual NP Is a Poor-Quality Provider	p. 253
Risk of Breaching Patient Confidentiality	p. 253
Risk of Violating a Patient's Right to Informed Consent	p. 255
Risk of Negligent Nondisclosure	p. 260
Risk of Poor Quality Ratings	p. 261
Risk of Disciplinary Action	p. 261
Risk of Medicare Fraud	p. 263
Business Risk Management	p. 264
Dealing with High-Risk Patients	p. 265
Reimbursement for Nurse Practitioner Services	p. 269
Payers	p. 269
Medicare	p. 269
Medicaid	p. 273
Indemnity Insurers	p. 273
Managed-Care Organizations	p. 274
Direct Contracts for Health Services	p. 279
Billing Third-Party Payers	p. 279
Billing Self-Paying Patients	p. 284
Credentialing Information	p. 286
The Employed Nurse Practitioner	p. 289
What Rights Does an Employed NP Have?	p. 289
Does an NP Need a Contract?	p. 290
Three Difficult Clauses	p. 291
How to Negotiate a Reasonable Agreement	p. 296
Interviewing	p. 303
Responsibilities of an NP Employee	p. 303
Employer's Evaluation of the NP's Performance	p. 304
Malpractice Insurance	p. 304
Collaborative Practice Agreements	p. 304
Sample Nurse Practitioner Collaborative Practice Agreement	p. 306
Sample Employment Agreement	p. 310
Practice Ownership: Legal Business Considerations for the Nurse Practitioner Owner	p. 321
Advantages of Practice Ownership	p. 321
Decisions Before Starting a Practice	p. 322
Business Planning	p. 338
Doing Business	p. 343
A Checklist for Setting Up a Practice	p. 358
Independent Contractor Agreement	p. 372
Sample Business Plan	p. 377
Professional Services Agreement	p. 393
Lawmaking and Health Policy	p. 399
The Legal Process	p. 399
The Judicial System	p. 400
Health Policy	p. 400
Laws and Rules That Affect NPs	p. 401
Changing Laws	p. 401
Understanding the Big Picture	p. 402
The Process of Changing the Law	p. 408
Conclusion	p. 414
Promoting the Profession to the Public	p. 417
Public Relations Steps	p. 418
Setting the Goal	p. 418
Developing the Plan	p. 418
Developing the Budget	p. 419
Working the Plan	p. 419
The Substance of the Message	p. 420
Supporting Data	p. 421
Collecting Impressive Facts	p. 423
Present Barriers to Fact Collection	p. 424
Not-So-Impressive Facts About NPs	p. 424
Dealing with the Downside	p. 425
A Simple PR Plan for a State NP Organization	p. 428
Some Talking Points for NPs	p. 430
Sample Fact Sheets on NPs	p. 433
Standards of Care for Nurse Practitioner Practice	p. 437
Definitions of Standard of Care	p. 437
Who is Monitoring Standard of Care	p. 437
How Should NPs Keep Current on Standard of Care?	p. 446
Credentialing	p. 446
Measuring Nurse Practitioner Performance	p. 449
Measuring Quality	p. 449
Multiple Measures, Multiple Measurers	p. 450
Productivity	p. 450
Housekeeping Performance Measures	p. 451
NCQA Measures of Clinical Performance	p. 451
Other Measures	p. 452
Formal Research	p. 452
Patient Ratings	p. 453
Peer Review	p. 453
Utilization	p. 453
How to Get an "A" on Performance Report Cards	p. 454
Ensuring Compliance	p. 454
NPs' Self-Evaluation	p. 456
Health Maintenance Flowchart	p. 457
Resolving Ethical Dilemmas	p. 459
Examples	p. 459
Analyzing the Ethical Choices Inherent in These Situations	p. 460
Ethical Analyses	p. 467
Strategies for NPs	p. 469
Opportunities in a Changing Field	p. 469
Opponents of a See-A-Nurse-First System	p. 470
What are the Challenges for NPs Attempting to Advance the Profession?	p. 470
Strategies to Implement Collectively	p. 471
Ten Organizational Strategies	p. 471
Index	p. 479
Table of Contents provided by Rittenhouse. All Rights Reserved.