Finding a Collaborating Physician in Mississippi
The regulatory landscape for nurse practitioners (NPs) varies widely by state and can be challenging to navigate. Zivian was created to handle the challenges of collaboration compliance so that you can focus on providing care. If you are an NP trying to find a collaborating physician in Mississippi, we’ve got you covered.
The state of Mississippi requires nurse practitioners to collaborate with a physician. Mississippi’s regulatory structure is Reduced Practice Authority.
In this post, we break down state regulations and key considerations for Mississippi NPs to establish a compliant collaboration with a physician.
Note: State regulations and requirements are subject to change. Always check with your state medical or nursing board to confirm the most up-to-date information.
What is the Practice Environment for NPs in Mississippi?
In which category does the state fall: NP independent practice, transition to independence, or collaboration required?
Collaboration with a physician is required.
Delegation Authority and Process
Is an agreement required?
Yes, a collaboration agreement is required.
What form of agreement is required and what are the requirements for the substance of the agreement?
Contact our team to learn more about the required components of a Mississippi collaboration agreement.
View a sample of a Mississippi collaboration agreement here.
Each collaborative relationship must include and implement a formal quality assurance / quality improvement program which shall be maintained on site and shall be available for inspection by representatives of the board. This quality assurance / quality improvement program must be sufficient to provide a valid evaluation of the practice and be a valid basis for change, if any.
Where must the agreement be stored?
The quality assurance / quality improvement program must be maintained on site and must be available for inspection by representatives of the Board of Nursing.
Does the agreement need to be filed with the state?
Physicians who wish to collaborate must add the NP to their file via the Medical Enforcement and Licensure System (MELS) Online Licensure Gateway, or its successor, prior to the commencement of patient care under the agreed protocol, and must submit all required information regarding the collaboration to the board.
Physicians who collaborate with an NP who either will be on-site with the physician or within seventy-five (75) miles are not required to submit the formal documentation (i.e., the protocol) to the board for approval.
The NP must submit the collaboration agreement to the Board of Nursing prior to beginning to practice. Additionally, the collaboration agreement must be submitted upon renewal or reinstatement of an NP’s license.
Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)?
Revisions to the collaborative agreement must be submitted to the Board of Nursing prior to implementation.
Changes or additions regarding practice sites shall be submitted to the Board of Nursing by the NP on forms supplied by the Board of Nursing. The NP may not practice at a site prior to approval by the Board.
The NP must notify the Board of Nursing immediately regarding changes in the collaborative relationship, including death, disability or relocation which would result in the NP not having a collaborative physician.
Who must sign the agreement?
NP, physician, and backup physician.
How often must the agreement be reviewed / reauthorized?
There is no requirement.
What are the qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?
"Physician" means any person licensed to practice medicine or osteopathic medicine in the state of Mississippi who holds an unrestricted license, whose practice or prescriptive authority is not limited as a result of voluntary surrender or legal/regulatory order, and who practices within the state of Mississippi for a minimum of twenty (20) hours per week or eighty (80) hours per month (does not include telemedicine or chart review).
Exceptions to the in-state practice requirement may be granted by the board, by and through the Executive Committee, in cases demonstrating good cause. Additionally, temporary permission may be granted by the Executive Director until the request can be heard before the Executive Committee.
What are the qualifications for the NP?
See requirements here.
Is an alternate collaborating physician required?
The collaborating physician must designate an alternate collaborating physician for when the primary collaborative physician is unavailable. Physicians with collaborative relationships with an NP must ensure backup physician coverage when the primary collaborative physician is unavailable, which includes being outside the approved distance for Extended Mileage. The backup physician must be a signatory to the protocol. In the event securing backup coverage is not possible, the primary collaborator and the APRN may agree, via terms written in the protocol, that no patients will be seen when the primary collaborator is unavailable.
Collaboration Requirements
Are there ratios / limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
There is no requirement.
Is there an express requirement to review a certain number / percentage of charts?
The collaborating physician must review the lesser of 10% or twenty (20) randomly selected charts of the NP every month representing the variety of patient types seen by the nurse practitioner.
The NP must maintain a log of charts reviewed that includes the identifier for the patient's charts, reviewers’ names, and dates of review.
Is there a requirement to meet and, if so, how often?
A collaborative physician must meet face to face, either in person or via video conferencing, with each collaborative NP once per quarter for the purpose of quality assurance, and this meeting shall be documented in the same manner as chart review. The physician denoted as the primary collaborator within MELS, or, in the absence of a noted primary, the physician performing most of the chart review, is ultimately responsible for all QI requirements.
Are there proximity requirements (e.g., between the NP/collaborator or practice site)?
Physicians who wish to collaborate with a NP who plans or anticipates practicing in a practice setting that is more than seventy-five (75) miles away from the primary office of the collaborative physician must submit an Application to the Board of Medical Licensure and appear personally (or by telephone interview) in front of the board to obtain approval for the collaborative relationship. The facts and matters to be considered by the Board regarding any collaborative relationship shall include, but are not limited to, how the collaborating physician and NP plan to implement the protocol, compatibility of practice (e.g., specialty compatibility or day-to-day practice differences), the method and manner of collaboration, the availability of backup coverage, consultation, and referral.
This mileage restriction does not apply for primary care practices where:
The collaborative agreement is between a primary care physician and a primary care nurse practitioner.
The physician is in a compatible practice (e.g., same specialty, treat the same patient population) with the nurse practitioner.
The physician utilizes electronic medical records (EMR) in their practice, has direct access to the EMR utilized by the APRN, and also utilizes EMR in the formal quality improvement program.
The collaborating physician practices in Mississippi for a minimum of twenty (20) hours per week or eighty (80) hours per month (this expressly does not include telemedicine hours).
Are there location-specific requirements (e.g., that collaborator must go to practice site at some frequency)?
The practice site must be located in Mississippi and reported to the Board of Nursing.
According to regulations, a practice site is defined as “the designated physical location in Mississippi which is the usual practice location as reported to the Board where the Board can conduct a site visit to evaluate the delivery of care by a licensee and compliance with laws and regulations regarding delivery of care by a licensee, and does not include the patient's home.”
Is remote supervision allowed / are there limitations on remote supervision?
Remote supervision is permitted, but the NP must be able to communicate reliably with the collaborating physician while practicing.
Additional Filing Requirements
Outside of filing the collaboration agreement, must the physician and/or NP file any separate forms?
See the additional filing requirements above.
Prescription Requirements and Controlled Substance Prescribing
What are the prescription requirements?
An NP cannot prescribe any medication without a good faith agreement subsequent to examination and medical indication thereof. According to regulations:
Every written prescription delivered to a patient or delivered to any other person on behalf of a patient, must be signed on the date of issuance by the APRN. Electronic prescription transmissions are allowed using standards established and approved by the United States Department of Health and Human Services - Agency for Healthcare Research and Quality (HHS- AHRQ). This does not prohibit the transmission of electronic prescriptions and telefaxed (but not emailed) prescriptions to the pharmacy of the patient's choice. Electronic transcription that complies with federal DEA language is allowed. All prescriptions shall contain a designation indicating whether it shall be dispensed as written or whether substitution is permissible.
Every written prescription issued by an APRN should clearly state whether or not each medication should be refilled, and if so, the number of authorized refills and/or the duration of therapy.
Written prescriptions issued by an APRN, bearing more than one noncontrolled medication, shall clearly indicate the intended refill instructions for each medication.
Any unused lines on a multi-line prescription blank shall be clearly voided by the issuing APRN.
An APRN shall not permit any prescription to be signed by any other person in the place of or on behalf of the APRN.
An APRN shall not pre-sign blank prescription pads or order forms under any circumstances.
In addition, an NP who prescribes any device or medication, including controlled substances, must maintain a complete record of the patient's examination, evaluation, and treatment plan.
Documentation of the patient shall include the diagnosis and reason for any prescriptions. Further, the APRN shall document the name, dose, strength, quantity, and the date prescribed of any prescription.
The patient record required by these regulations shall be maintained at the practice site of the APRN.
The patient record required by these regulations shall be maintained by the APRN for a minimum period of two (2) years.
The Board has the authority to conduct random audits of patient records at APRN practice sites. These records shall be made available for inspection by representatives of the Board.
There are additional requirements for use of “diet medication.”
What are the requirements for controlled substance prescribing?
According to state regulations, “authorized APRNs may prescribe Schedules II, III, IV, or V. Application for this privilege requires an additional fee. Additionally, an application must be submitted to the Drug Enforcement Administration (DEA).”
Find a Collaborating Physician in Mississippi with Zivian Health
Zivian handles all the challenges of compliance so that you can stay focused on providing great patient care.
If you are in need of a collaborating physician in Mississippi, contact us today!
Sources
Mississippi Board of Nursing: Advanced Practice Registered Nurse
Miss. Code Ann. § 73-15-20
30 Miss. Admin. Code Pt. 2630
30 Miss. Admin. Code Pt. 2840
