Legal Considerations Before Opening a Nurse Practitioner Practice in Tennessee

Opening a practice is one of the most significant decisions a nurse practitioner can make. In Tennessee, the questions are not only clinical and financial. They are regulatory, and the answers depend on your specific credentials, services, and setting. This article outlines questions to work through; it is not a determination that any particular model is permitted.

Licensure and certificates

Tennessee Board of Nursing rules (Chapter 1000-04) address the advanced practice registered nurse certificate and the certificate of fitness. Under those rules, a certificate of fitness is what authorizes an APRN to perform acts of medical diagnosis, develop a medical plan of care, and prescribe. Confirm that your RN license, APRN certificate, national certification, and certificate of fitness are current and match the services you intend to offer.

Collaboration and prescribing

Tennessee law requires nurse practitioners who prescribe to file a notice with the Board that includes the name of the collaborating physician, and Board rules require a collaborating physician who complies with the jointly adopted medical and osteopathic board rules. State guidance describes a written protocol, developed jointly, dated and signed by both providers, and maintained at the practice site. Before opening, understand what collaboration requires of you and of your collaborating physician, including chart review, site visits, and recordkeeping, and put the arrangement in writing.

Business structure

Entity choice affects liability, taxes, and ownership. In healthcare, it can also intersect with professional licensure and with who may own or control a practice. Evaluate structure with those questions in mind, not only tax considerations.

Payers, credentialing, and contracts

Credentialing with payers takes time and should be planned well ahead of opening. Review payer, lease, vendor, and employment agreements before signing.

Compliance foundations

A new practice should have HIPAA privacy and security policies, a security risk analysis, business associate agreements, consent processes, and documentation standards in place from the start.

Bottom line

The right path depends on your license, specialty, services, setting, and current law. An individualized assessment before you sign leases or contracts can prevent expensive corrections later.