Can a NP be a primary care provider and work with other health care providers?

[satyadhi]

If I live in a state that allows NP's to work completely independently of physicians and choose to do home health can I...

1. Have some longterm home health clients whom I will be their primary care provider. They don't have another doctor, I take care of everything. I prescribe and change their medications and make all the decisions between me and the patient.

2. Have some short term home health clients who I am not the primary care provider. I have connections with some local doctors who call me up when they want someone to provide some home health care for their patients. I follow the doctor's orders for the patient and do not change meds unless the doctor gives the ok.

It seems like a nice combination... is it possible? Maybe it is a silly question?

[NRSKarenRN, BSN, RN]

so what are some of the differences between what an np who does home health would do and a np who works as a primary care provider who does house calls would do?

could i do a little of both?

see the previously posted article posted on medscape nursing website--free registration required it is the premier website to learn about advanced practice nursing , especially legal and billing issues.

ask the experts - can i set up an independent practice providing house calls?

posted: 08/14/2000

carolyn buppert, np, jd

...if medical, then the np would seek third-party payment under the appropriate medical cpt (current procedural terminology) codes. medicare will pay nps for home visits, under the following conditions:

1. the procedures billed conform with the requirements stated in the cpt manual.
   
2. there is an applicable diagnosis, identifiable with an icd-9 code (international classification of diseases, 9th edition).
   
3. the visit is medically necessary.
   
4. the np's documentation conforms with the health care financing administration's documentation guidelines.
   
5. the np is a medicare provider.
   
6. the np follows the general rules for filing claims under medicare.
   

medicaid likewise will pay nps for home visits, if the np is a medicaid provider and conforms with medicaid billing requirements. commercial insurers may or may not pay nps for home visits. an np starting a practice should determine which commercial payers are prevalent in his or her geographic area and query each insurer about 1) coverage of home visits, 2) reimbursement of nps for home visits, and 3) procedures for obtaining reimbursement.

if the visits are primarily of a nursing nature, an np will have to become a provider of home care services. states may require the providers of home nursing services to 1) get a certificate of need and 2) get a license. medicare requires a physician's order for in-home nursing services and periodic recertification that the services are necessary. presently, an np cannot order nursing services in-home, no matter whether the np is performing the nursing services or whether a separate home care company is performing the services. commercial insurers may have rules that differ from medicare. commercial insurers may or may not pay for nursing services provided in the home.

( note: medicare regs still permit physician only to sign homecare plan of tratment orders still in 2010! all our np practices use their collaborating md who we communicate with for orders. karen)

if the np plans to perform both medical and nursing services, the np may have to meet the requirements stated in both of the paragraphs above....

[satyadhi]

Seems frustrating to me, but I guess that is what I'll do...

I hope to move to Arizona where NPs can be primary care providers, and hopefully I can find a couple of physicians who would like to open an office together in order to cut back on costs. Even though we will be independent of each other hopefully I could make a deal with the doctors in the office to sign stuff that requires a physicians signature.

OR

I could find a nice Sikh girl who is a doctor and marry her:redbeathe:redbeathe:redbeathe:D

[KateRN1]

But then your mothers would expect her to stay home and have babies. ;-)

Good luck. Check out the Visiting Physicians Association, if they have a branch in AZ, it may be a good fit.

[Willow Moonsidhe]

http://www.medscape.com/viewarticle/721049?src=mp&spon=24&uac=145912SZ

Interesting article on how Health Care reform is going to affect this.

~Willow