Understanding the Different Types of Nursing Jobs and Corresponding Compliance Issues – Part Two

Nurses perform many different tasks including helping patients live more comfortable and healthier lives, providing preventive care, attending to patients when patients are sick, and helping to save their lives.

In part One of our nursing health compliance series we discussed the various types of nursing professions and the corresponding academic requirements and job duties. In this article:

• We’ll discuss some of the many different types of nursing businesses and the related individual business compliance issues.
• We’ll then discuss many of the federal, state, and local laws and regulations that govern most nursing practices.

In part three, we’ll discuss more regulatory issues and one very practical way, using an MSO (managed service organization), to address some of the compliance issues.

It is essential that nurses who run their own businesses in any capacity understand the unique requirements for their field of business and the full range of healthcare regulations. Our lawyers are ready to help you understand those requirements.

What are the different types of nursing business enterprises and corresponding compliance issues?

Nurses work in different environments including hospitals, medical group practices, individual practitioners, nurse freelancing, and other environments.

According to Nurse Journals, other nursing professions (some of which we’ve already discussed in detail) include:

• Medical spas. These facilities focus on providing beauty, cosmetic, and aesthetic treatments – under the supervision of a licensed healthcare professional. The professional may be a dermatologist, a plastics surgeon, or another type of physician. Nurses, often nurse practitioners, who work for medical spas often seek, and may be required to have, certification from an appropriate medical board.

One of the issues involving nursing and medical spas that we’ve discussed is physician supervision of nurses. Medical spas should have standard protocols that specify how a registered nurse can function under MD or DO supervision. The Medical Board of California requires that doctors ensure the training, education, and experience of the RNs the doctors employ.

The MD/DO must take an active role in supervising the RN including providing oversight, direction, inspection, guidance, and evaluation of the RN. The RN must be able to immediately contact the physician if the situation requires more care than the RN knows or if there’s an emergency. “For Nurse Practitioners (NPs), there is more practice autonomy and that usually requires at least a collaboration agreement with the MD and possibly a supervision agreement, depending on the State.” Here are different requirements for physician assistants.

• Home-healthcare. As the population ages and most people can’t afford to or can’t qualify to live in a nursing home, home healthcare is expanding. Nurses who work in this sector need an appropriate state license, to understand the Medicare and Medicaid funding laws, and many other regulations.
• Cannabis agency. Nurses are beginning to understand and advise about the health benefits of CBD oil including helping people with cancer and pain management. A few options include opening a CBD oil business (where legal) and educating the public. Nurses who work in this field need to understand the federal, state, and local regulations that govern the use of CBD products.
• Intravenous infusions. Nurses are now setting up businesses to help people with non-hospital use of IV hydration which administers hydration, vitamins, and other treatments – to help people have more energy and improve their skin quality. Nurses may start an independent business, participate in a franchise, or provide these services in other settings.
• Specialized care providers. Common examples include nursing professionals who work as certified lactation specialists, health and wellness nurses, doula service nurses, and nurses who provide other categories of care.

Other professions for nurses based on the type of practice (as opposed to the nurse’s professional status) include:

• Being a nurse writer or marketing professional
• A legal nurse consultant
• An independent massage therapist
• Acupuncturist
• Medical or pharmaceutical sales
• A nurse health tutor

What are some of the business considerations nurses should consider when operating their own business?

The best course of action for nurses in all nursing professions and all businesses is to consult with an experienced healthcare nursing lawyer who will help you understand and prepare for the key legal issues that may apply to your type of nursing business.

What are some of the types of compliance issues that nurses need to know?

Nurses need to be aware of many different types of compliance issues. When nurses work for hospitals or medical practices, the hospital or doctors who run the practice should explain and monitor the various healthcare regulations nurses need to know. Nurses who operate independently in any way – such as in work areas where the nurse submits bills to Medicare, Medicaid, or other public or private payors need to understand the compliance issues that govern their business. Nurses who move from practice to practice can benefit from understanding the compliance issues for their type of nursing work.

Some of the different types of nursing compliance issues include:

• Education and certification requirements
• HIPAA compliance and other patient privacy laws
• Telecommunications with patients
• Referrals and fee-splitting including Stark Law and the Anti-Kickback Statute (AKS)
• The unlicensed practice of medicine
• The corporate practice of medicine laws
• Scope of practice requirements
• IV Hydration Therapy Business Regulatory Compliance

Some of the business issues include:

• Managed Services Organizations (MSOs) – a valuable tool for addressing many healthcare compliance issues
• Dispute resolution
• Mitigation

HIPAA compliance and other patient privacy laws

One of the key compliance issues nurses need to understand includes HIPAA. HIPAA is the Health Insurance Portability and Accountability Act of 1996. HIPAA was enacted to protect the healthcare information of patients. Most healthcare professionals are required to comply with HIPAA’s privacy laws and security rules. These rules provide national standards for accessing, using, and sending protected patient information. Generally, the information that must be protected is patient information that is kept electronically. Most patient information is currently stored and transmitted using electronic software systems.

The ePHI (electronic patient healthcare information) includes the patient’s contact information, diagnosis, test results, treatment, vital sign information, and prognosis.

Our experienced healthcare lawyers will explain what information must be secured, the circumstances when information can be shared (such as when patients provide written consent), what nurses and physicians must do in case of a breach, and how nurses can show they are in compliance with HIPAA.

Telecommunications with patients

More and more, medical practices are communicating with patients remotely. Even with the pandemic emergency hopefully winding down, many practices have seen the benefits of speaking with patients through telehealth and telecommunication services. Different states have different laws and requirements. Generally, states require that doctors meet with patients in person before conducting telemedicine services.

Telehealth generally includes, according to the US Department of Health and Human Services, the ability of a healthcare provider to provide care through the internet via a patient’s computer, tablet, or a smartphone. The options include speaking with a healthcare provider through a video conference, sending and receiving using a secure messaging email service, and apps that remotely monitor a patient’s health such as routinely checking a patient’s vital signs.

Some of the benefits of telehealth include limited physical contact when people are contagious, speaking with a healthcare provider from anywhere, minimal wait times, and an increased ability to access specialists.

Some of the telemedicine issues we’ve discussed that apply to nurses include the following:

• HIPAA compliance since information is being transmitted electronically.
• The standard of care must match the standard of care a doctor would have provided in person or according to the standard of care nurses or other non-physicians normally provide.
• Properly establishing the patient relationship.
• The “supervising or collaborative physician must be available in person or electronically to consult if and as needed.”
• Compliance with laws against advertising or promoting services or products in which the healthcare provider has a financial interest.
• Compliance with the laws that apply to conversations across state lines.

Referrals and fee-splitting including Stark Law and the Anti-Kickback Statute (AKS)

Fee-splitting and referrals. Two of the main laws that regulate fees are Stark Law and the Anti-Kickback Statute (AKS). Stark Law prohibits splitting fees between a healthcare provider and a designated healthcare facility in which the provider has a financial interest.  The AKS prohibits paying or providing remuneration in return for referrals. Stark and AKS generally apply to bills submitted to Medicare and Medicaid. Many states have similar laws.

Nurses need to understand these laws if the nurses are involved in patient billing or patient referrals – either as an employee of a hospital or medical practice – and especially if the nurses bill or refer patients directly. Experienced healthcare lawyers can explain what exceptions may apply and how nurses can demonstrate compliance with these fee-splitting/referral laws.

The fee-splitting and referral laws must be considered if, for example, an RN or any other type of nurse markets their services, has a website, or has any financial relationship with a doctor based on referring patients to the doctor’s medical practice.

Nurses need to understand the general laws that apply to every type of nursing profession such as HIPAA and corporate practice of medicine laws. Nurses also need to understand the laws and regulations that are specific to their type of nursing care such as medical spas and IV hydration therapy. Violations of these laws may affect your license, ability to bill Medicare and Medicaid, and ability to provide quality care to patients. Violations may also result in civil and, in the case of the AKS, criminal penalties.

Nurses and nursing businesses should contact Cohen Healthcare Law Group to discuss their legal and healthcare compliance requirements. Our experienced healthcare attorneys advise healthcare providers including nurses about healthcare compliance laws.