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Featured Practice Question

What is the best way of ordering home health for patients at the time of hospital discharge? Can nurse practitioners have physicians co-sign orders in EMR? Can we as NPs order home health and put the physician's name in the order in the EMR instead of ours but still sign it?

A physician signature is only required for the initial order to open care in home health. All the remaining care can be ordered by an NP, as NPs are "attending providers" in Home Health Care for Medicare, but are unable to certify eligibility without physician documentation of necessity (establish and sign the plan of care). Once the physician has established that patients need PT, OT, home health, etc. in the plan of care, then the NP can order these services. You should not order home health and sign on behalf of the physician unless you actually have an order. This presentation from the Centers for Medicare & Medicaid Services provides more details.

Featured Legal Question

I'm a functional medicine practitioner and have an office without physician oversight. I do neurofeedback to patients. I’m pretty much functioning under the scope of my RN license since neurofeedback is a subset of biofeedback. I'm a licensed physician in the Philippines as well and have a current license. In the informed consent that they sign, it is clearly stipulated that I'm NOT a licensed physician in the U.S. and I make sure that they understand that, although I will tell them that I'm a physician in the Philippines and that I’m licensed as an RN and an NP in the U.S.

Many of the testimonials on my website address me as “Doctor”. Is there any violation when patients address me as Doctor even though they have clearly been told that I'm not a doctor in the U.S.?

This can absolutely cause a problem for you since you are not a physician in the U.S. The BRN could come after you for misrepresenting yourself. Do you have a DNP? If you do, the patient can call you “Doctor.” Many patients call NPs “Doctor” because culturally there is not a word for NP. The BRN and Medical Board are very touchy about NPs being called “Doctor,” especially if you do not have a doctorate degree in the U.S.

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