As a nurse practitioner collaborating with a physician to manage a group of patients within long term care facilities or skilled nursing facilities I find it imperative to implement and consistently utilize a multidisciplinary team approach. A team approach that actively incorporates members from the other health care areas such as MDS, Social Services, Physical/Occupational/Speech Therapy, Pharmacy, Dietitian and if applicable the Surgeon, Infectious Disease and a Specialty Physician – all to ensure for the best patient outcome. 

Lastly, it is also important to familiarize yourself with current policies and procedures such as understanding Medicare and your State’s Board of Registered Nursing laws. 

For example:

• Medicare requires that the initial visit (history and physical), for the purpose of certifying that the patient requires skilled care, must be performed by a physician. An NP may, however, make a “medically necessary” visit without an initial physician visit; this could occur when a newly admitted Medicare patient in a skilled nursing facility develops a problem that requires medical evaluation and intervention, before being seen by the physician.
• The NP is responsible for the accuracy and adherence to regulations for all billing claims submitted under the NP’s Medicare provider number, even though the actual completion of forms may be done by a billing service.
• Medicare requires NPs to be certified by a recognized national certifying body such as American Nurses Credentialing Center (ANCC) in order to become a Medicare provider.

• Medicare defines collaboration as “a process whereby a NP works with a physician to deliver health care services within the scope of the NP’s professional expertise with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms as defined by Federal regulation and the law of the state in which the services are performed.