the reimbursement maze and legal haze.
5 Tips for Nurse Practitioners on how to get 
paid and not get sued, from Carolyn Buppert, attorney.
1. Understand and apply Medicare’s rules for billing physician services provided by nurse practitioners. For example, when a nurse practitioner performs a physician service, it may be billed to Medicare under the nurse practitioner’s name and provider number or, if “incident-to” or “shared billing” rules are followed, under the employer physician’s name and number. A failure to follow the rules could lead to a charge of fraudulent billing.
For details, see these resources:
Safe, smart billing and coding for evaluation and management
2. Learn how to negotiate decent terms of employment. The principles are:
- Know what you want, and be able to articulate it.
- Describe what you have to offer, including the amount of revenue you can generate.
- Learn what the other party wants.
- Be able to articulate why what you have to offer fits with what the employer wants.
- Put it in writing.
For details, see these resources:
Negotiating terms of employment: For nurse practitioners
The nurse practitioner’s business practice and legal guide
Productivity plans for nurse practitioners: How and why
3. Know the complaints and conditions that are red flags for malpractice. The top 3 are:
- Breast lump, nipple discharge, breast rash or enlarged lymph node in supraclavicular or axillary area
- Chest pain in an adult
- Lower abdominal pain
Rule out the worst thing first.
For more recommendations on how to avoid malpractice, see these resources:
Avoiding malpractice: 20 cases, 10 rules, five systems
Prescribing: Preventing legal pitfalls
4. Understand the reimbursement system for your practice setting. For example, hospice agencies may get reimbursement for nurse practitioner services from Medicare Part A and Medicare Part B. In order for a hospice to be reimbursed under Part B for physician services provided by a nurse practitioner employed by the hospice, the following statements must be true:
- the patient is enrolled in hospice and
- the patient has designated the nurse practitioner as attending physician.
For more details, see these resources:
5. With every prescription you write, go through a SCRIPT analysis (Side effects; Contraindications; Right medication, dose, frequency, and route; Interactions; Precautions; Transmittal). Why? Because here are 2 common prescribing errors, with examples:
- Clinician failed to adjust doses for renal dysfunction, and the patient had an adverse reaction and sued.
- Clinician failed to inform patient of side effects. The patient had that side effect, claimed he would not have accepted the prescription had he known of the possibility of that side effect and sued for lack of informed consent.
For more recommendations, see these resources: