Help us end the collaborative agreement requirement!!

prairienp · Feb 4, 2011

I never said we "can't" do it. I "could" do it but I "won't." I have seen first hand the eduation provided in medical school and then the education provided in NP school (and this is a large, well known state school program with a non-existent fail rate). And NPs who want to "play" MDs are COMPLETELY fooling themselves if think the education is even remotely comparable. We are prepared to do what we do very well, but we are not prepared to be 100% on our own. I'm just one of those who thinks you should go to medical school if you wanted it that way.
So go ahead and do it. That's fine. I just don't think you are prepared properly to do it and I'll always believe that. I would never go to an independent NP provider.

I agree, if "you" don't feel properly prepared "you" should avoid independent practice. To be clear I have yet to "play" MD, and have no intentions of doing so in the future. Collaborative agreements are far more than problematic in the provision of health care than the narrow scope described. Collaborative agreements are control mechanisms for MDs and Insurance companies to regulate NP practice. I think it is silly that NPs are not allowed to admit patients to hospice, not able to order durable goods for our patients, unable to order PT, all of which may fall under the auspices of a collaborative agreement.

The vast majority of independent NPs with whom I talk with do not seek opening up their own office. They also are not seeking to play MD or not collaborate with other MDs/FNPs. Collaboration and a collaborative agreement have very different meanings in my world.

nomadcrna, DNP, CRNA, NP · Feb 6, 2011

OMG, I doubt you are a NP, no offense intended.

Try telling that to the many states were we ARE independent. LOL

Won't do it. Will never do it. We don't have the education to back up the independent practice. Do we know enough to do what we do? yes. Do we know enough to be completely independent ? no. Does the public deserve to know we have someone to collaborate with ? Yes

nomadcrna, DNP, CRNA, NP · Feb 6, 2011

Do I need to have a collaborative agreement to see Medicare patients and bill directly, even though I am in an Independent Practice State?

A. When the regulations were written to implement the 1997 Balanced Budget Act authorization of direct reimbursement of nurse practitioners by the Center for Medicare and Medicaid Services (CMS), a requirement for physician collaboration was inserted. The regulations require: written documentation of the nurse practitioner’s scope of practice and the process used to refer patients to physicians if the patient’s needs fall outside the nurse practitioner’s scope of practice or require consultation from a physician. There is no requirement to provide a copy of the documentation of scope of practice and collaboration to CMS in order to be reimbursed. Regulations regarding coverage of nurse practitioner services and collaboration are found below. Section C, 3, ii describes what nurse practitioners in independent practice states should do. A recent informal survey of nurse practitioners working in independent practice revealed that following these processes, they are able to obtain Medicare reimbursement for their billed services.

c. Medicare Part B covers nurse practitioners' services in all settings in both rural and urban areas, only if the services would be covered if furnished by a physician and the nurse practitioner-

1. Is legally authorized to perform them in the State in which they are performed;

2. Is not performing services that are otherwise excluded from coverage because of one of the

statutory exclusions; and

3. Performs them while working in collaboration with a physician.

i. Collaboration is a process in which a nurse practitioner works with one or more physicians to

deliver health care services within the scope of the practitioner's expertise, with medical

direction and appropriate supervision as provided for in jointly developed guidelines or other

mechanisms as provided by the law of the State in which the services are performed.

ii. In the absence of State law governing collaboration, collaboration is a process in which a nurse

practitioner has a relationship with one or more physicians to deliver health care services. Such

collaboration is to be evidenced by nurse practitioners documenting the nurse practitioners'

scope of practice and indicating the relationships that they have with physicians to deal with

issues outside their scope of practice. Nurse practitioners must document this collaborative

process with physicians.

iii. The collaborating physician does not need to be present with the nurse practitioner when the

services are furnished or to make an independent evaluation of each patient who is seen by the

nurse practitioner.

Thanks for clarifying. However, how would this law bypass the federal requirement imposed by CMS that mandates that in order to bill Medicare and Medicaid, the NP has to have a collaborative agreement with a physician?