Everything a Nurse Practitioner Practice Needs

Nurse practitioner practice authority is set by each state, and the American Association of Nurse Practitioners (AANP) sorts states into three practice environments. Your state's category decides how much of the practice you can run on your own and what paperwork has to be in place before you see a patient.

Some states that grant full practice also require a transition-to-practice period first. Minnesota, for example, requires a newly licensed nurse practitioner or clinical nurse specialist to practice at least 2,080 hours within a collaborative agreement, in a hospital or integrated clinical setting where APRNs and physicians work together. Requirements like this change through legislation, so we confirm the current rule with your board of nursing before we plan your practice.

Where your state requires a collaborative agreement or supervision, we prepare the agreement from our attorney-drafted templates, track any hour requirements toward independent practice, and keep the agreement current when a collaborating physician changes. Doctor Rebrand is not a law firm; questions about your own arrangement are handled alongside your attorney.

A nurse practitioner holds two layers of licensure: a registered nurse license and an APRN license or authorization in the same state. The Nurse Licensure Compact (NLC) lets nurses who live in a compact state hold one multistate RN license. It covers the RN license only, not APRN practice, and if you move your primary residence to another compact state, you apply for licensure in the new home state within 60 days.

The APRN Compact is a separate agreement for the APRN layer. Under its model language, an APRN multistate license authorizes practice in each party state in the same role and population focus as in the home state, independent of a supervisory or collaborative relationship, and includes prescriptive authority for non-controlled drugs. Controlled substance prescribing still has to meet each state's own requirements, and the APRN is accountable to the practice laws of the state where the patient is located. The compact's current status is shown below.

Until a compact covers every state you need, the path is a separate APRN license in each state. We plan the order, gather your verifications, and track each state's renewal and continuing education requirements. A few boards, including the Alabama and Mississippi Boards of Nursing, do not allow a third party to complete or submit the application; there, we prepare everything and you submit it.

DEA treats nurse practitioners as mid-level practitioners: you can register only when the state where you practice authorizes you to handle controlled substances, and DEA requires all of that state's licensing requirements to be met first. If you practice in more than one state, DEA requires a separate registration in each one.

Prescriptive authority for controlled substances is where state rules differ most, from full authority under the board of nursing to authority tied to a collaborating physician. We confirm what your state requires, file the state registration where there is one, then file the DEA registration for that state. Telemedicine prescribing of controlled substances follows separate federal rules, shown below.

Payers credential nurse practitioners as their own providers. For Medicare Advantage plans, CMS requires credentialing of every health care professional who is permitted to practice independently under state law, with recredentialing at least every three years. To bill Medicare, a nurse practitioner must enroll, and for nurse practitioners applying for a Medicare billing number for the first time, Medicare requires state authorization as an NP, national certification as an NP and a master's degree in nursing or a doctor of nursing practice degree.

Being listed as a primary care provider (PCP) is a separate question from being in network. Whether a plan assigns members to a nurse practitioner as their PCP depends on the plan and the state. We ask each plan how it panels nurse practitioners in your state, apply under the panel that fits your practice, and request an exception where a panel is closed.

Medicare pays nurse practitioners directly, on assignment only, at 80 percent of the lesser of the actual charge or 85 percent of what a physician is paid under the Medicare Physician Fee Schedule. If state law allows it, nurse practitioners can bill all levels of evaluation and management codes. Medicare's own coverage rules also ask for collaboration with a physician as state law defines it; where the state has no collaboration law, you document your scope and your relationships with physicians for issues outside it. The collaborating physician does not need to be present or see each patient.

Incident-to billing is the other path. A service a nurse practitioner furnishes can be billed under a physician at the full fee schedule rate only if it meets every incident-to requirement: the physician performed the initial service that started the course of treatment, stays actively involved in managing it, and provides direct supervision, except for behavioral health services, which Medicare allows under general supervision. New patients and new problems do not qualify, because the physician has not started that course of treatment. Getting this wrong is an overpayment, so our billing team applies these rules claim by claim and bills under your own NPI whenever incident-to does not fit.

An independent NP practice is a covered entity with the same HIPAA duties as any physician practice: a security risk analysis, a designated security official, written policies, workforce training and business associate agreements with every vendor that touches patient information. We build that program, train your staff, collect your BAAs and repeat the cycle every year.

For practices that see patients across state lines, we also track each state's telehealth and prescribing rules, and review website forms, analytics and ad pixels so patient information never reaches an ad platform.

Opening on your own follows the same order every time: confirm your state's practice authority and any collaborative agreement, form the entity with your attorney and accountant, get the tax ID and organizational NPI, start credentialing right away, and set up your EHR, e-prescribing, patient portal and payments while applications are pending.

Some nurse practitioners open cash-pay, membership, aesthetic or weight-loss practices. Nurse practitioners are among the practitioners who may opt out of Medicare, and we set up the model you choose, from membership pricing and agreements to a Medicare opt-out if you need one.