New Nonphysician Practitioner Rules Change How You Supervise

Q. Did the new laws regarding nonphysician practitioners (NPPs) change how many charts the supervising physician must review?

A. The law no longer specifies a number or percentage of charts the physician must review when delegating prescriptive authority to a nonphysician practitioner. 

The new law replaces the old site-based regulatory structure with a more collaborative model based on periodic quality assurance reviews and a new prescription authority agreement. The parties to the prescriptive authority agreement —  the supervising physician and an advanced practice registered nurse (APRN) or physician assistant (PA)  determine the number of charts the physician will review.

The number may vary from one practice setting to another. Factors such as the length of time the APRN or PA has been in practice, the length of time the physician and APRN or PA have practiced together, whether they practice together in the same practice setting, and the complexity of patient care needs are all considerations for making this determination.

The law still requires that a physician provide adequate supervision of delegates. In any given case, the number or percentage of charts reviewed may be an important factor in determining the quality of the physician's supervision.

To find out more:

  • See TMA's Delegation of Duties webpage, where you will find links to the Texas Medical Board's FAQs on prescriptive delegation and more.
  • Read TMA's newly revised Nonphysician Practitioners: Hiring, Billing, and Delegation of Duties for Nonphysician Practitioners,  second edition, now available through the TMA Education Center.

Have NPP-related billing questions? See:

Published April 29, 2014

TMA Practice E-Tips main page

Updated Aug. 15, 2014

Last Updated On

June 23, 2016

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