Best Practices for Advanced Practice Providers (APPs)

Know what the licensed state specific details are for an APP

For APPs, one of the most important things to understand is whether there are supervision or collaboration requirements that are determined by their role and the state they practice in. Typically, the key elements outlined in regulations include:

1. Which services APPs are allowed to perform independently and which require direct supervision. Many states allow local practice determination in conjunction with education, training and experience.
2. When supervision is required in a state by its licensing board, who is designated as the supervisor, and what are the associated requirements and documentation of those requirements.
3. Collaboration may be required, and while it is less stringent than supervision, it still requires documentation to meet the requirements of the licensing board.
4. Which certifications and qualifications need to be reviewed and how often. Many states require APRNs to maintain national certification.
5. What documentation or agreements need to be in place and how often these need to be updated.
6. Many states have transitions to independence that may include “mentorships” or supervision agreements for a specified period of time. The APP should know their requirements during transition, implement them, and document them so that independence can be achieved.

The following "best practices" are based on reviews of claims that involve APPs

1. There is a continuum of the level of risk in settings and clinical presentations, and APPs should have a clear understanding of clinical situations, based on risk, in which:
   • They can see the patient independently.
   • They are required to consult the physician and document that discussion; and/or
   • They are required to have the physician see the patient, with the physician preparing their own documentation.
2. APPs know the limitations of their scopes of practice and when to seek assistance.
3. There is a network of physicians willing to provide support and backup.
4. There is compliance with rules and regulations set forth by the applicable state licensing board to fulfill education requirements.
5. Evidence-based practices and best practices are followed.
6. Practice mitigates risk and promotes patient safety.
7. APPs understand the employment contract and expectations/limitations determined by the employer. A written collaboration policy and/or agreement is in place if required by regulations.
8. Uniform documentation policies are used by all members of the medical team.
9. APPs avoid being misidentified as "physicians."

10. Understanding the specifics for the licensed state on prescriptive authority. Some states have specific requirements for controlled substance prescribing.

The information provided herein does not, and is not intended to constitute legal, medical, or other professional advice; instead, this information is for general informational purposes only. The specifics of each state’s laws and the specifics of each circumstance may impact its accuracy and applicability, therefore, the information should not be relied upon for medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation.

Article originally published in Copic’s Advantage Program Insight 4Q22 newsletter.