Response – The Role of APRNs in NPI Registration and Opioid Addiction Treatment

Response – The Role of APRNs in NPI Registration and Opioid Addiction Treatment

Response 1

Thank you for your post. It is indeed accurate that the National Plan & Provider Enumeration System (NPPES), through its website, provides a pathway for APRNs to obtain their NPI numbers. As captured in your post, qualified and market-ready APRNs can log in to the website and apply for their NPI. The role of nurses in the modern healthcare landscape has significantly expanded in recent years. In Full Practice Authority States, Nurse Practitioners can practice independently without physician supervision (Martin et al., 2023). As your post captures, Washington is one of the FPA states. This allows NPs practicing in the state to have prescriptive powers, including for Schedule V controlled substances. They can also order, administer, and dispense medications.

I am also impressed by your choice of career progression. There is a growing need for addiction medicine in the US and abroad. The US is currently grappling with the opioid epidemic. Opioid use and misuse are a health concern in the county. They have been implicated in significant morbidity and mortality (Jalali et al., 2020). The fight against opioid overuse and subsequent addiction draws caregivers from diverse health disciplines. APRNs have a role to play in addiction treatment and health promotion related to opioid use (Renda et al., 2023). Your role as a primary care physician, with specific interests in addiction treatment, places you in a better position to provide care to people with addiction and those at risk of addiction.

Subsequently, the buprophenone waiver is specifically important to caregivers involved in addiction treatment. As stated in the post, the waiver will enable NPs to prescribe buprophenone. This will considerably enhance access to this medication, positively impacting the communities affected by opioid dependency.

References

Jalali, M. S., Botticelli, M., Hwang, R. C., Koh, H. K., & McHugh, R. K. (2020). The opioid crisis: A contextual, social-ecological framework. Health Research Policy and Systems, 18(1). https://doi.org/10.1186/s12961-020-00596-8

Martin, B., Buck, M., & Zhong, E. (2023). Evaluating the impact of executive orders lifting restrictions on advanced practice registered nurses during the COVID-19 pandemic. Journal of Nursing Regulation, 14(1), 50–58. https://doi.org/10.1016/s2155-8256(23)00068-6

Renda, S., Eshkevari, L., Glymph, D., Knestrick, J., Lundy, K. S., Ortiz, M., Sharp, D., Solari-Twadell, P. A., & Valentine, N. M. (2023). Mobilizing nurses to address the opioid misuse epidemic. Nursing Outlook, 71(6), 102033. https://doi.org/10.1016/j.outlook.2023.102033

Response Post 2

Thanks for your post. I agree with your post on the process of obtaining an NPI number through the National Plan & Provider Enumeration System (NPPES) platform. The platform provides a simplistic approach for qualified and market-ready APRNs to obtain an NPI number and subsequently use it for Medicare billing. The Center for Medicare and Medicaid Services (CMS) outlines the significance of the NPI number and outlines the persons mandated to obtain the NPI number (Harrison et al., 2020). As captured in your post, licensed NPs willing to practice independently must have the number for Medicare billing purposes.

Texas is one of the reduced practice states. This means that APRNs are not allowed to practice independently in the state. As mentioned in your post and highlighted in the Texan statutes on the scope of APRN practice, APRNs must have a formal agreement with a physician to be able to prescribe controlled substances. Limitations in the scope of NP practice have, over time, sparked controversies on the space of nurses in the healthcare landscape (Schorn et al., 2022). Many argue that a reduced and restricted practice environment impedes efforts toward expanding access to healthcare in some communities (Kleinpell et al., 2023). However, with many states moving to adopt the FPA status for APRNs, Texas may be one of the states that will grant APRNs prescriptive authority in the coming days.

Following this, Buprenorphine waiver remains integral to the fight against opioid addiction and the opioid epidemic at large. It allows NPs, among other caregivers, to prescribe the medication. For NPs aspiring to pursue spaces in addiction treatment, this certification may enhance their significance in managing opioid dependency and addiction. As captured in your post, training on addiction medicine can be obtained from federal institutions such as the American Society of Addiction Medicine (ASAM) and the waiver certification from the Substance Abuse and Mental Health Services Administration (SAMHSA).

References

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to aprn practice: Policy and regulatory implications during COVID-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9

Harrison, J. M., Germack, H. D., Poghosyan, L., & Martsolf, G. R. (2020). Surveying primary care nurse practitioners: An overview of national sampling frames. Policy, Politics, & Nursing Practice, 22(1), 6–16. https://doi.org/10.1177/1527154420976081

Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a national survey: Ongoing barriers to aprn practice in the United States. Policy, Politics, & Nursing Practice, 23(2), 118–129. https://doi.org/10.1177/15271544221076524

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PEER RESPONSE 1:

Ijaz Mahmood posted

For Medicare billing, steps are required for a future nurse practitioner to get an advanced practice nursing NPI number. I will apply for my NPI number through the National Plan & Provider Enumeration System (NPPES) website (https: Once I am done with my course and get my national certification exam, I will get a license from this site: (http://nppes. cms. hhs. gov/#/). This entails signing up for the site, confirming my identity, and submitting the necessary details of my practice and credentials. To avoid hitches in the billing, as early as possible in my career is advisable.

Response – The Role of APRNs in NPI Registration and Opioid Addiction Treatment

Washington State currently has APRNs’ scope of practice complete independence, which allows them to diagnose, treat, and prescribe without collaborating with a physician. While practicing as an APRN, I will be required to prescribe controlled substances, but this calls for me to get a DEA registration. It should be noted that Washington does not possess additional furnishing licenses for APRNs. The APRN licensing and prescription are under the state’s Nursing Care Quality Assurance Commission (Koch & Washington-Brown, 2021). This state does explicitly not require a collaborating physician to prescribe APRNs, which makes them independent.

Given my future career plan of being a primary care physician with a focus on addiction medicine, the buprenorphine waiver is an additional accomplishment that can be useful. This waiver, often referred to as the X-waiver, enables specific categories of health practitioners, such as nurse practitioners, to prevail buprenorphine for the treatment of opioid use disorder. Buprenorphine is a primary component of medication-assisted treatment (MAT) that has the potential to change the course of a patient’s fate by helping those who suffer from opioid dependency (Ghanem et al., 2022).

To prescribe the buprenorphine, I will need a waiver, and I will have to go through special training to take this course. Now, np has undergone about 24 hours of training to make them eligible for the waiver as of 2021. This training focuses on issues like opioid Properties, patient identification, and treatment plans. The cost of training may differ; nevertheless, the general cost can come up to $ 200–500. Once the training is over, I will be required to do the notification of intent, which will enable me to be given a waiver by the Substance Abuse and Mental Health Services Administration (SAMHSA) (Finnegan et al., 2024).

However, it is advisable to emphasize that there has been a change in the requirements for prescribing buprenorphine; some recent modifications targeted easing barriers to their provision as life-saving treatments. Nevertheless, updating my knowledge regarding current standards and practices will be important throughout my career. The buprenorphine waiver is important because it enables NPs to take their time and manage the complex needs of patients with opioid use disorder. This capability is critical because the opioid epidemic is still a real and growing problem. Thus, expanding the diffusion of medication-assisted treatment in primary care settings would eliminate stigma and enhance the accessibility of evidence-based therapies (Ghanem et al., 2022).

The buprenorphine waiver must be kept through continued education and by the prescription rules. It is to be noted that there is no unique process for renewal of the waiver, but the holder needs to keep the DEA registration current and adhere to the best practices of addiction medicine. This may encompass enrolling in continuing education courses or becoming a member of professional organizations in substance use disorder treatment. Altogether, I would like to highlight that, as the next step towards becoming a nurse practitioner in Washington State, I have several significant steps to undertake. These are getting my NPI number for billing claims, knowing the laws regarding prescriptions in different states, and getting a buprenorphine waiver. In doing this, I will be able to write compelling and evidence-based papers concerning my future clients, especially those with substance abuse disorders.

PEER RESPONSE 2:

Aldo Gonzalez posted

To obtain an Advanced Practice Registered Nurse (APRN) National Provider Identifier (NPI) for Medicare billing as a Nurse Practitioner (NP), the application process is conducted online via the National Plan and Provider Enumeration System (NPPES) website (https://nppes.cms.hhs.gov/#/). Once you’ve obtained your NP license, you can apply for an NPI by submitting your personal and professional information, including your state licensure and practice details. An NPI is essential for billing Medicare and other insurance providers for healthcare services, and you can apply as soon as you are licensed as an NP.

In the state of Texas, APRNs must fulfill several requirements to gain prescriptive authority. APRNs are required to hold a valid RN license, complete a graduate-level NP program, and pass a national certification exam in their specialty (such as Family Nurse Practitioner or Adult-Gerontology NP). For prescriptive authority, Texas APRNs need a formal agreement with a supervising physician, especially for prescribing controlled substances. APRNs are allowed to prescribe Schedule III-V medications but can only prescribe Schedule II drugs under specific circumstances, such as for hospice patients or in certain hospital settings. Additionally, APRNs must obtain a DEA number to prescribe controlled substances.

One certification that can be particularly useful for NPs specializing in addiction or pain management is the buprenorphine waiver. This waiver allows NPs to prescribe buprenorphine, a medication used to treat opioid use disorder. To receive this waiver, NPs must complete 24 hours of training on addiction medicine, which is available through organizations such as the American Society of Addiction Medicine (ASAM). The cost for this training typically ranges from $200 to $300. After completing the training, NPs apply for the waiver through the Substance Abuse and Mental Health Services Administration (SAMHSA). This certification is important in addressing the opioid crisis and expands an NP’s scope of practice in addiction treatment. The waiver requires renewal every three years, depending on state and DEA requirements.