Independent Nurse Practitioner Considerations
What are Considerations a Nurse Practitioner has to investigate before beginning an independent business? Consider the inpatient and outpatient arena. Make sure you discuss your state’s regulations for Nurse Practitioners. How is a bill for services submitted?
Discussion 6: Establishment of an Independent Practice
The contemporary healthcare practitioners are facing an influx of health care system, which necessitates healthcare reforms. Nurse practitioners (NPs) are poised to play a pivotal role in applying the PPACA as part of the health care reforms. NPs can fill varied positions involving vast levels of independence and responsibility owing to their clinical training and advanced education. There are various options in practice specialty, such as being employed by hospitals or medical practice or being self-employed. An NP could establish independent businesses in primary health care, obstetrics, and pediatrics to provide much-needed services to the growing numbers of persons who could be covered for healthcare services (Dunphy et al., 2019). The professionals should adhere to the scope of practice in the state they offer healthcare. In Texas State, the NP scope of practice has restricted practice laws, which limit the NP’s ability to participate in as a minimum in one element of practice. The Texas laws do not permit NPs to practice independently as they need closely-regulated supervision of physicians for NPs to provide care. (Zaccagnini & Pechacek, 2021). The 2013 Senate Bill 406 requires supervising physicians to maintain a written and signed prescriptive authority agreement with NPs.
Moreover, NPs require business skills as effective advocates for the imminent healthcare reforms and successful decision-makers in private practice. There are several critical considerations that nurse practitioners should investigate before establishing an independent private practice in the inpatient and outpatient environment. First, the self-employed NPs should take into consideration the reimbursement policies that govern their income as reviewed by the third-party payers with distinctive policies and fee schedules. These payers are classified into seven categories: Medicare, Medicaid, Indemnity insurance firms, Managed care organizations, Workers’ compensation, auto liability, and Veterans Administration. Additionally, there is private pay with no health insurance. The CMS policy accords billing approvals for the non-physician practitioners, even the NPs. Some of these payers permit NPs and offer similar reimbursements to physician billing. There are carriers who either pay the NPs according to the distinctive billing rules or no specialty for billing (Bahouth et al., 2013). They instruct NPs to submit their bills under the provider number of a physician.
Another critical consideration is the business essentials to ensure sufficient funding for the provision of health services and resources utilized in supporting their independent practice. This involves planning using operating budgets, maintenance of adequate cash flows, payment for services, oversight of account receivables, implementation of collection policy, control of overhead costs, and utilization of the three financial statements. Three accounting reports can be used in monitoring the effects of monthly transactions occurring in practice: balance sheet, operating statement, cash-flow statement, and net Income Statements. An NP should review the four documents to monitor the health and performance of the business. Another consideration is the current reimbursement rules that govern the clear identification of the appropriate diagnosis and service codes for every patient’s visit to ensure the business’s success.
As a robust partner, the nurse practitioner should possess reimbursement knowledge to ensure the optimization of the billing payment (Mariano, 2013). The specific documentation of the critical components such as the CPT® Coding for Unlisted Procedures, CPT® Coding Rules such as the CPT® Unlisted Codes, CPT® Modifiers, and Add-on Codes, New CPT® Requests, as well as CPT® Level II Codes, and ICD-9-CM Codes could make significant differences in the allowable reimbursement (Buppert, 2017). The nurse practitioner should also review the standard policies that are applied for controlling and supporting practice decision-making in fraud, abuse and compliance plans, risk management, HIPAA, and performance improvement. The NP could also benefit from the collection of data that allows the demonstration of the measurement and communication value, performance quality, and management of the healthcare practice. These considerations will affect the NP’s ability to flourish and achieve their business and professional goals.
Bahouth, M. N., Blum, K., & Simone, S. (2013). Transition into hospital-based practice: A guide for nurse practitioners and administrators. New York: Springer Pub. Company.
Buppert, C. (2017). Nurse practitioner’s business practice and legal guide. Burlington, MA: Jones & Bartlett Learning.
Dunphy, L. M. H., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing – an interprofessional approach. Philadelphia, PA: F.A. Davis Company.
Mariano, C., American Holistic Nurses’ Association., & American Nurses Association. (2013). Holistic nursing: Scope and standards of practice. Silver Spring, Md: American Nurses Association, nursesbooks.org.
Zaccagnini, M. E., & Pechacek, J. M. (2021). The doctor of nursing practice essentials: A new model for advanced practice nursing. Burlington, MA: Jones & Bartlett Learning.