Scope of Practice Varies by State

May 5, 2015

Advanced practitioners have various qualifications, but be sure you understand your state's scope of practice laws.

Advanced practitioners may be qualified to conduct physical exams, order and interpret tests, diagnose and treat illnesses, prescribe medications, and educate patients, but the state in which you reside may impose limits on their scope of practice. Indeed, all states allow NPs and PAs to write prescriptions for all medications at some level. Some states also require that a physician be onsite with a nonphysician provider, while others only require that they be available by phone. And still others restrict NPs and PAs from ordering tests or billing independently for their services. All factor into their ability to generate revenue for your practice. "As a practice, you should be well aware of what your state requirements are before you even pursue a relationship," says Max Reiboldt, CEO of healthcare advisory firm Coker Group, noting reimbursement rules differ as well from third-party payers so practices should not hire anyone until they know for sure that their group of insurers will pay for her services.

As part of the due diligence process, it's equally important to understand how NPs and PAs differ. In a nutshell, NPs are registered nurses with advanced education and clinical training who are licensed to practice either independently, as is the case in 20 states, or with physician oversight. They have some degree of prescriptive authority in all states, and receive nursing accreditation and graduate education (master's or doctoral degree), along with national board certification in neonatal, pediatric, family, women's health, adult, geriatric, psychiatric, or acute care. They provide a range of healthcare services including the diagnosis and management of common and complex medical conditions. PAs, on the other hand, are licensed to practice only with physician supervision. They complete an accredited program, working collaboratively with a physician responsible for delegating medical tasks in accordance with state regulation. PAs also have prescriptive authority in all states.