Lessons Learned From Nurse Practitioner Independent Practice

A Conversation With a Nurse Practitioner Entrepreneur

Joyce A. Hahn, PhD, RN, NEA-BC, FNAP; Wesley Cook, APRN, FNP-BC, CPSN


Nurs Econ. 2018;36(1):18-22. 

In This Article


APRN entrepreneurship opportunities burgeon as the provider shortage widens and the public places greater trust in nurses given proven outcomes. While nurses should not feel limited to develop business models that mimic medicine, many entrepreneurs with innovative delivery models will find more secure revenue streams if they participate with public and commercial payers alike. Securing commercial-payer credentialing can be problematic and frustrating given the lack of representation of nurses on payer boards, historically physician-driven credentialing models, and poor payer understanding of APRN value and role autonomy. APRN entrepreneurs wanting to add commercial-payer revenue independent of physician involvement should first assess ability to do so with their local insurance regulations and consult with other local APRN entrepreneurs about their business plan. Prudent entrepreneurs will consult an attorney for regulatory interpretation, contract negotiation, and rejection appeals. It is also advisable to hire a well-vetted credentialing firm after developing a credentialing plan that will be APRN-led and firm-managed. Do not see patients without a signed payer contract unless the payer has issued written intent to pay on the date of service, or lost revenue may never be recovered. Appeal credentialing denial, if necessary, with attorney assistance, remembering everything is only negotiable if a negotiation takes place. Most importantly, be patient: credentialing takes as long as it takes, often 90–120 days from initial application.

If the business plan is well-founded, solidly built, and led by an APRN who manages his/her own expectations, it is time to bring the business plan off the page into practice. The credentialing process is certainly frustrating, cumbersome, and lengthy, but often necessary to deliver innovation to a wider market share. While opportunities may abound for the APRN entrepreneur, patients will not see the quality benefits of APRN innovation unless good plans are put into practice effectively. If you have a good plan, the time to dig in is now.