Legal/Professional Issues for Advanced Practice Nurses

 
 
  • RNFAs and Scope of Practice I have noted that an RNFA writes postoperative orders, including orders for pain medications (narcotics). Should I be concerned that this RNFA is violating the Nurse Practice Act?
  • Procedures a Primary Nurse Practitioner May Perform Which procedures would you consider to be outside the scope of practice for a primary care nurse practitioner? State practice acts are vague in terms of specific procedures or acts.
  • Family Nurse Practitioners and Practice in Specialty Areas I notice many family nurse practitioners practicing in specialty areas. Is this legal? Carolyn Buppert, NP, JD, responds.
  • Can an FP Supervise an NP Who Provides Gynecologic Patient Care? A family planning clinic uses adult nurse practitioners to deliver gynecologic care to patients. Could a board-certified family practice physician supervise the NP for this type of client?
  • Can NPs Prescribe for Family Members or Themselves? Can nurse practitioners prescribe medications for family members or themselves? Are there circumstances when this would be reasonable?
  • Health and Behavioral Assessment Codes If Medicare patients are being seen who are not diagnosed with mental illness, but may benefit from evaluation that focuses on biopsychosocial factors, how should I bill?
  • What Happens When an APN Is Sued? What happens when an APN is sued? How and where is the event recorded? What impact may it have on their practice and insurance rates if found liable, or not liable?
  • Reasonable Staffing Level in a University Setting How many patient visits should a nurse practitioner manage daily and what is the maximum number of patients an RN should see in an 8-hour shift, in the college health setting?
  • Rural Health Clinic I want to open a family health clinic. How do I know whether this area qualifies for rural status? Are billing and NP regulations different in rural areas? How and where should I start?
  • NPs and Controlled Substances Is it legal for a physician to give verbal orders while an NP fills out a controlled-substance form? Should a physician give an NP presigned controlled-substance forms to complete?
  • New EMTALA Regulations and NPs Is there a restriction in the new EMTALA regulations that would prohibit nurse practitioners from seeing emergency room patients?
  • How Do I Ensure That I Receive My Remaining Income? I quit my job but my employer has not paid my remaining income. How can I get the money that is owed to me? Also, my employer has not returned the funds I have in my retirement account.
  • Insurance Fraud to Save a Patient Money on Prescriptions? Can I treat "androgenic alopecia" with finasteride (Proscar) -- a treatment for BPH -- instead of the more expensive finasteride (Propecia) used to treat male pattern hair loss?
  • Who Is Responsible if our Billing Is Audited? In my office there has been a great deal of debate over billing the NPs' services. Who is ultimately responsible for correct billing in our office if we were ever audited?
  • Bill Commercial Insurers for Palliative Care? What is the best method for a nurse practitioner (NP) to bill commercial insurers for palliative care consultations? Does the NP need an individual contract or must they bill under a physician?
  • Coding Previously Seen Patients in Our New Practice If NPs see patients they saw previously at another practice, should the patient's visit be coded as a new patient in our new practice?
  • Hospital Privileges I am a family nurse practitioner and I want to apply for hospital privileges. What do you recommend as the best approach?
  • Malpractice Insurance Does malpractice insurance protect only for the time you had the policy? If I am not working as a nurse practitioner now, drop my policy, but get sued for something from the past, what happens?
  • Should Patients Be Asked to Return Unused Opioids? What are the legal issues related to asking a patient to return the unused portion of a previously prescribed opioid to our office (in order to destroy it) before prescribing a new one?
  • Telehealth Can I expand my practice by counseling via email and telephone and charge for these services?