Nurse Practitioner's Business Practice and Legal Guide

by Carolyn Buppert

Overview

"Nurse Practitioner's Business Practice and Legal Guide, Eighth Edition is a must-have resource for every new or current nurse practitioner (NP). Drawing from the author's extensive experience as an NP followed by nearly 30 years as a practicing attorney focused on the many and varied legal issues affecting NPs, it is unlike any other text. This unique resource explains and analyzes the legal issues relevant to NPs in a straightforward and easy-to-read approach. The Eighth Edition discusses NP competencies, how the Doctor of Nursing Practice (DNP) degree relates to NPs, the differences in primary care and acute care NPs, definitions of medical bio-ethics terminology, malpractice cases and the lessons to learn from them, emerging issues in health policy, guidelines around prescribing opioids and controlled drugs, clinical performance measures, electronic health records, and other relevant and practical topics specific to NPs.In how many states can NPs write prescriptions? What can an NP do if an insurance company refuses to pay the bill for a patient's visit? What should be covered in an employment contract? What is involved, legally, when starting a private practice? How does an NP know when to consult a physician? Nurse Practitioner's Business Practice and Legal Guide, Eighth Edition answers these questions and more, making it an indispensable resource for practicing NPs, students, those employing NPs, and attorneys representing NPs or the medical facilities in which NPs are employed"--

Product Details

ISBN-13:	9781284286434
Publisher:	Jones & Bartlett Learning
Publication date:	11/29/2023
Edition description:	8th ed.
Pages:	550
Sales rank:	954,207
Product dimensions:	6.90(w) x 9.50(h) x 1.30(d)

About the Author

Carolyn Buppert, JD, MSN, is an attorney who focuses on the legal issues affecting medical practices and nurse practitioners. She is the author of eight books and an instructional CD. Her clients include hospitals, health systems, physician and nurse practitioner practices, a health insurance company, nursing homes, schools of nursing and a certification organization. She is a frequent contributor to The Journal for Nurse Practitioners and Medscape.com. Links to her many articles and books can be found on her website, www.buppert.com. She lectures extensively on avoiding malpractice, negotiating contracts, how to avoid legal pitfalls when prescribing, and how to comply with federal regulations on billing and coding, HIPAA, and hospital relationships with physician practices. She practiced as a nurse practitioner for 16 years before devoting her efforts full time to law. She lives and practices as an attorney in Portland, OR.

Table of Contents

Preface	ix
Chapter I    What Is a Nurse Practitioner?	1
Definition of Nurse Practitioner	1
A Nurse Practitioner, by Any Other Name	2
Services Provided by NPs	3
Preparation and License Requirements	5
Initials	6
Areas of Practice	6
Legal History of NPs	6
Demographics	7
NPs in Primary Care	7
NP versus PA: What's the Difference?	11
NP versus Physician: What's the Difference?	13
NP versus RN: What's the Difference?	15

NP versus CNS: What's the Difference?	16
Where Do Nurse Practitioners Practice?	18
Appendix I-A: State-by-State Definitions of                          Nurse Practitioner	19
Appendix I-B: State-by-State Titles for                          Nurse Practitioners	36
Chapter 2      Legal Scope of Nurse Practitioner Practice	39
Professional Association Definition of Scope                          of Practice	39
Statutory versus Regulatory Scope of NP Practice	40
Physician Challenges to NPs'Scope of Practice	41
Need for Clarity of Scope of Practice	41
NP Scope of Practice Compared with RN Scope                          of Practice	42
NP and MD Scope of Practice Compared	46
Mandated Physician Involvement with NP Practice	47
Appendix 2-A: State Laws Defining NPs' Scope of                           Practice, State by State	50
Appendix 2-B: State-by-State Requirement of                           Physician Collaboration, If Any	76
Chapter 3      State Regulation of Nurse Practitioner Practice	104
How Laws about NP Practice Evolve	104
What Is Regulated?	105

Appendix 3-A: Agency That Regulates Nurse                            Practitioners, State by State	107
Appendix 3-B: Nurse Practitioner Qualifications                            Required by Law, State by State	110
Chapter 4      Federal Regulation of the Nurse Practitioner                       Profession	125
Medicare	125
Medicaid	129
Nursing Homes	129
In-Office and Hospital Laboratories under CLIA	130
Self-Referral by Health Care Providers, under the                           Stark Acts	130
Prescription of Controlled Substances under the DEA	131
Reporting to the National Practitioner Data Bank	132
Patient Confidentiality	132
Discrimination in Hiring and Firing	132
People with Disabilities under the ADA	132
Appendix 4-A: Documentation Guidelines for                           Evaluation and Management Services	134
Chapter 5     Prescribing	170
Controlled Substances	170
Guidelines for Prescribing Legally	174
Appendix 5-A: State-by-State Law on Prescriptive                         Authority	176
Chapter 6    Hospital Privileges	208

Are Hospital Privileges an Issue for NPs?	208
Do PCPs Need Hospital Privileges?	209
What If Health Plans Require PCPs To Have                         Admitting Privileges?	210
Do NPs Need Hospital Privileges for Advancement                         of the Profession?	210
Do Individual NPs Need Hospital Privileges?	211
Who Has Hospital Privileges?	212
Does Federal Law Support Full Hospital Privileges                          for NPs?	213
What Does It Mean To Have Hospital Privileges?	214
Levels of Privilege	214
The Application Process	214
Expense	215
Denial of Privileges	215
Expect Change	216
Chapter 7  Negligence and Malpractice	217
What Can Happen to an NP Who Is Sued?	218
Life Cycle of a Lawsuit	219
What Is Malpractice?	219
Elements of Malpractice	220
Examples of Lawsuits against NPs	221
The National Practitioner Data Bank	226

Working with Practice Guidelines	227
How To Prevent Lawsuits	228
What To Do If Sued	228
Communication	228
Liability of Collaborating Physicians	229
Malpractice Insurance	231
Chapter 8  Risk Management	233
Risk of Making a Clinical Error	233
Risk of Being Sued for Malpractice When There                          Was No Clinical Error	237
Risk of Public Perception That the Individual NP                           Is a Poor-Quality Provider	237
Risk of Breaching Patient Confidentiality	237
Risk of Violating a Patient's Right to Informed                         Consent	238
Risk of Negligent Nondisclosure	243
Risk of Poor Quality Ratings	245
Risk of Disciplinary Action	245
Risk of Medicare Fraud	247
Business Risk Management	248
Dealing with High-Risk Patients	249
Chapter 9  Reimbursement for Nurse Practitioner Services	252
Payers	252

Medicare	252
Medicaid	256
Indemnity Insurers	257
Managed-Care Organizations	257
Direct Contracts for Health Services	262
Billing Third- Party Payers	262
Billing Self-Paying Patients	268
Conclusion	269
Appendix 9-A: Credentialing Information	270
Chapter 10  The Employed Nurse Practitioner	273
What Rights Does an Employed NP Have?	273
Does an NP Need a Contract?	274
Three Difficult Clauses	275
How To Negotiate a Reasonable Agreement	281
Interviewing	287
Responsibilities of an NP Employee	288
Employer's Evaluation of the NP's Performance	288
Malpractice Insurance	289

Collaborative Practice Agreements	289
Appendix 10-A: Sample Nurse Practitioner                           Consultation Practice Agreement	290
Appendix 10-B: Sample Employment Agreement	295
Chapter 11   Practice Ownership: Legal and Business                      Considerations for the Nurse Practitioner Owner	306
Advantages of Practice Ownership	306
What Is Stopping NPs?	307
Decisions before Starting a Practice	308
Business Planning	324
Doing Business	330
Appendix 11-A: A Checklist for Setting Up a Practice	345
Appendix 11-B: Independent Contractor Agreement	360
Appendix 11-C: Sample Business Plan	365
Appendix I I-D: Professional Services Agreement	382
Chapter 12    Lawmaking and Health Policy	389
The Legal Process	389
The Judicial System	390
Health Policy	391
Laws and Rules That Affect NPs	391
Changing Laws	391
Understanding the Big Picture	392

The Process of Changing the Law	398
Conclusion	406
Chapter 13    Promoting the Profession to the Public	407
Public Relations Steps	408
Setting the Goal	408
Developing the Plan	408

Developing the Budget	409
Working the Plan	409
The Substance of the Message	410
Supporting Data	411
Collecting Impressive Facts	413
Present Barriers to Fact Collection	414
Not- So -Impressive Facts about NPs	414
Dealing with the Downside	415
Appendix 13-A: A Simple PR Plan for a State NP                           Organization	418
Appendix 13-B: Some Talking Points for NPs	421
Appendix 13-C: Sample Fact Sheets on NPs	424
Chapter 14    Standards of Care for Nurse Practitioner Practice	428
Definitions of Standard of Care	428
Who Is Monitoring Standard of Care?	428
How Should NPs Keep Current on Standard of Care?	442
Credentialing	442
Chapter 15   Measuring Nurse Practitioner Performance	444

Measuring Quality	444
Multiple Measures, Multiple Measurers	445
Productivity	446
Housekeeping Performance Measures	447
NCQA Measures of Clinical Performance	447
Other Measures	449
Formal Research	450
Patient Ratings	450
Peer Review	451
Utilization	451
How To Get an "A" on Performance Report Cards	451
Ensuring Compliance	452
Appendix 15-A: NPs' Self Evaluation	455
Appendix 15-B: HEDIS-Based Health Maintenance                           Flowchart for Ages 18 and Over	456
Chapter 16   Strategies for Advancing the Profession	458
Opportunities in a Changing Field	458
Opponents of a See-a-Nurse-First System	459
What Are the Challenges for NPs Attempting To                           Advance the Profession?	460
Strategies To Implement Collectively	461
Ten  Strategies	461
Index	472

Editorial Reviews

5 Stars! from Doody

Reviewer: Kathleen Lent Becker, MS, CRNP (Johns Hopkins University School of Nursing)
Description: This book provides an up-to-date review of the legal foundation for nurse practitioner practice at the state and federal level and describes in detail the business aspects of nurse practitioner practice.
Purpose: The purpose is to provide a resource for the nurse practitioner on the legal and business aspects of practice. The author, an attorney and nurse practitioner, specializes in legal issues affecting nurse practitioners. The author discusses scope of practice issues, state and federal policy issues, contract negotiation, reimbursement, negligence and malpractice, as well as ownership issues related to practice.
Audience: The book is written for the both students and the practicing NP. Students will find helpful the introductory chapters on scope of practice, role definition, and state and federal regulation as well as how to negotiate a contract. Practicing clinicians will be particularly interested in the chapters on privileging, malpractice, reimbursement, measures of quality, and methods to promote the profession to the public.
Features: While providing a broad overview of the business and legal aspects of nurse practitioner practice, the author is able to present complex material related to reimbursement, contract negotiation, ownership, and quality measures in a straightforward and thoughtful manner. The chapter on promoting the profession to the public is particularly insightful.
Assessment: This is an important and timely book. Every new graduate should read the chapter on employment negotiation before their first interview. The clarity of author's description of complex business and legal issues related to practice is a welcome addition to the literature.

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