EP 2: Licensure to Liftoff — Boards, State License, NPI, DEA

Obtaining and maintaining NP licensure has never been easier, thanks to our NP Launchpad hosts! In this episode of our podcast, we cover how to acquire and organize the most important documents to propel your career, and secret strategies you can use to apply for board exams early. Plus, get the lowdown on DEA registration, protecting your privacy, compact licenses, and state-by-state considerations. 

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Have questions, an inspiring story, or clinical pearls that you’d like to be heard on air? Email nplaunchpad@fhea.com. 

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Transcript

Voiceover 0:01

Welcome to NP Launchpad, presented by Fitzgerald Health Education Associates, the podcast created for newly graduated nurse practitioners navigating the transition from school to clinical practice. Hosts Jason Gleason, Christopher Gleason, and Vanessa Pomarico-Denino deliver real talk, real experiences, and practical guidance to help you succeed from day one. So if you're ready, let's jump right in.

Christopher Gleason 0:29

Welcome back, everyone. I hope you enjoyed our first episode. I'm Christopher and I'll be the moderator for this episode. Today we're going to do a deep dive on licensure, DEA, NPI numbers, and APR and Compacts. Joining me are my friends and colleagues, Jason and Vanessa. How's it going, Vanessa?

Vanessa Pomarico 0:46

Good thanks. Nice to be back with both of you.

Jason Gleason 0:50

I am thrilled to be back. We had such a great time last week, didn't we? Yeah. Vanessa, what did you think of our first episode?

Vanessa Pomarico 0:56

I thought you knocked it out of the park. Lots of great information, and hopefully our listeners are going to feel the same way.

Christopher Gleason 1:04

Absolutely, absolutely. So this is just a reminder as we move forward. Please remember you can reach out to us with your comments, clinical tips, and questions that we can share during one of our episodes. We love connecting with you, our friends and colleagues from across the country and around the world. Please reach out to us at nplaunchpad@ fhea.com. Again, that's nplaunchpad@ fhea.com. Now into legal issues. So this is a quick disclaimer. This is education only. As your friends and colleagues, we are not giving you legal or clinical advice. And we encourage you to reach out to legal professionals, local mentors, practice managers, state agencies for specific issues you may have. So let's dive into what our hot topic discussion is for this week. And this one is going to be licensure. All right. What would you recommend doing first when getting your license squared away for practice? Vanessa?

Vanessa Pomarico 1:55

So one of the first things I tell people is to be organized. I'm like the organizing queen. So make sure you have checked all of the boxes before you apply for anything. And make sure you have all of your required documents in order so you're not scrambling around to find things. And then that just delays the whole process. And probably one of the most important things you need to start with is to make sure that your school transcripts are in hand. Now they can't be a copy. They actually have to be a sealed document from the school. And that can take several weeks, especially if you're graduating in like May when the rest of the school is graduating, and they have thousands and thousands and thousands of transcripts to get ready to get out. So make sure those school transcripts, you've requested them enough in advance and that you've given yourself enough time to get the sealed transcripts before you start applying for anything because you can't move forward without that official document. Excuse me. How about you, Jason? What do you think?

Jason Gleason 2:55

Gosh, you know, I would tell our audience out there, our friends and colleagues, take it easy on yourself because this is not easy stuff, right? I love what you said, Vanessa, and that's what I would share too. Be organized, super organized when it comes to your license because you have a lot writing on it and you don't want delays. But also don't get freaked out by it. Just take it easy and be easy on yourself, but stay organized, stay on top of things, and have a system in place. How did I do that? I actually built in my PC, Apple PC, whatever you have out there. Um my PC, I actually built a file for Licenger and just start dumping any documents in there, anything that you have. But the nuances, like Vanessa said, they want, they won't take a copy. You have to have the actual original transcript signed off from your school. So there's nuanced things like that that you have to be really particular about. But be organized, but be easy on yourself. Chill out, it's gonna be all right, and you'll get through it. But uh stay on task because if you don't, there's gonna be big delays. And I've seen this happen where um some of my colleagues, you know, they'll apply for a new job, they become an NP, they're board certified, licensed, but there might be a little delay in that process. And sometimes employers move on to the next candidate because you're up against a firm deadline. You got to start work by this day. So stay on task. Don't take a chill pill where you're chillaxing too much, right? Be easy on yourself, but don't fall asleep in the process. But uh yeah, be easy on yourself, stay organized, you'll get through it just fine.

Christopher Gleason 4:15

One little tip I would pass on to y'all is that with AANP, you can actually apply early for your certification to take your boards. You can send in your information. They will take an unofficial transcript at first, and then once you get your official transcript, you can actually send that off to them to uh get ahead of the game as far as your boards and taking your boards. The and I would definitely reiterate what Venice and Jason said, organization is key here. You don't want to get caught behind. So next we're gonna talk a little bit about some tips for our friends. Okay, so licensed or checklist. What do what do we do first? What to avoid? All right, we need to confirm. You need to make sure you have your prerequisit prerequisites are active, that you have your registered nurses' license um on board, you have your national NP certification, which I talked a little bit about when we talked about the uh AANP boards. The um the other boards that I was referring to are uh the American Nurses Credentialing Center, the ANCC. Make sure to be on point with their state board of nursing, know the application steps, know the fees, the transcripts that they require, know the verification process, their backgrounds, the check and fingerprints. And those background checks and those fingerprints can be very, very time consuming. So make sure you're on point with them and make sure to get them done early. Also know your prescriptive authority steps. Um do you have make sure to have your pharmacology CEs if they're required, any collaborative agreements if they're required, or forms? And then if you're looking to gain like a controlled substance permit from the DEA, some some state states require a separate state controlled substance registration before drug enforcement administration or the DEA uh can license you. And keep a launch folder, copies of the licenses, certs, immunizations, your CV, your IDs, and receipts in one place. And that kind of goes back to what we were discussing earlier about make making sure to maintain organization. And then you're gonna avoid common delays, mismatch names and dates, missing attachments, unanswered BON emails or board of nursing emails, and late fingerprints. That's going back to, like I said, that that background and those fingerprints, they can be really time consuming. So make sure to get those done early if you can. All right. Now, Vanessa and Jason, is there any tips that you would um want to lay out there to our friends?

Vanessa Pomarico 6:31

So in terms of the pharmacology, it was a great point that you brought up, Chris. Uh, you know, that pharmacology sneaks up after uh sneaks up on you, and in five years, you don't want to be scrambling thinking you have to get all of your CEs in the month before your uh certification expires. So keeping that ongoing list, and again, I have the same thing uh as Jason does on my computer. Uh, and I also keep a hard copy because I'm I'm that, you know, um really organized about those kind of things. It's in my firebox. God forbid my house should go down, and that's coming with me. Um, but your pharmacology CE, so I know in the state of Connecticut, we have 25 uh CEs that are mandatory every year. So there are things like um infectious disease, um, you know, that kind of thing, uh domestic violence. And we have to have a certain number of CEs every year for the state of Connecticut. But the C the pharmacology CEs, as I said, they can sneak up. So rather than waiting, I would say try to start doing some of your CEs a little bit every year to get them out of the way. And then one of the other requirements that we never think about is our CPR, um, because we have to have our CPR. And so keep everything copies of it. Sometimes I've I've uh you know been applying for you know, speaking somewhere or, you know, I'm uh hospital privileges or whatever, and they say, can we have a copy of your CPR? That's another thing that I scan into my online file, along with my driver's license and my certification and my APRN licenses and RN licenses as well, but uh uh as well as our uh CPR as well. What about you, Jason? What do you think?

Jason Gleason 8:15

Gosh, you know, I agree with so much of what the two of you already mentioned. Two items stand out to me. The stinking fingerprints, right? I I remember a colleague in our state of Montana, which is the fourth largest state geographically in the entire country. And it's not easy to travel places, right? But my colleague actually had to travel 150 miles to get fingerprints done. Ridiculous, right? But it's just a hurdle you got to jump through. So be very aware of that, because that as Christopher mentioned, that can delay you a lot in the process. Big delay there, potentially. Most organizations are right there in your city or your hometown. They can do your fingerprints, but but be ready for any kind of variables like that, because they are out there, trust me. And then the other thing besides fingerprints, is having that file is so important. So you're ready to go from day one. I would certainly agree with that. But missing emails, like if an employee if a potential employer emails you like a job offer, imagine this scenario where you miss that email. Because how many of you out there, raise your hand right now? If we could see you, many of you'd be raising your hand, thousands of you would be raising your hand right now. We are inundated with junk mail. Even with our junk mail filters on, we get tons of emails. I know I at least get 150 a day. It's ridiculous. And so, what I would recommend you do this. So when you become an NP, or if you're already an NP, I'd consider this as well, recommending this for you, is that you have your personal email. And then, like what I did in Outlook is I set up a nurse practitioner email, like Jason Gleason, NP at whatever, right? So set up a person, you already have your personal email, then set up a professional email, and that's the one you want to put on your CVs, your resumes, your applications. Share it with an employer. If you've already submitted your application and CV to them, please tell update them with the new email address. That way you're not inundated with all of these other emails where things can get lost. Because if you miss that, don't depend on them to call you because it's common practice now where they send job offers. You know, now we even know these days that you can get terminated by email, right? It's heartless, but but that happens. So look out for those important emails. And the best way to do that is to segregate them off to the side in your professional email account. So I'd recommend, again, two things set up a professional email account just for your professional um issues and things that you're looking forward to getting through your email and interacting with others on. And then those stinking fingerprints, be ready for any variables because that can delay it quite a bit. So two pieces of advice.

Christopher Gleason 10:41

Great advice, both uh Jason and Vanessa. And one thing I would actually add to that, the uh both of you had brought up the idea of having a folder on your on your laptop or your desktop, you know, kind of just that focuses on just the licensure itself. What I would also recommend is maybe having a file on your phone as well. Just scanned copies of those things that are available to you. Because like Vanessa alluded to, sometimes you get asked for these records in just the most random of places. But for the most part, all of us have our phones on us. So having a copy on there might be key as far as uh making sure that those are available to you. That's great.

Vanessa Pomarico 11:11

Great idea. I also think about putting it up in the cloud.

Christopher Gleason 11:17

So and one of the things that's yeah, that's a great idea. Absolutely.

Vanessa Pomarico 11:21

And the reason why I put it in the cloud is um, and I don't know about other health systems, but our health system, because of a data breach, we don't have any external internet at all. As a matter of fact, if I let's say I want to um I want to access something on WPATH, which is a website that I go to for transgender health, I had to actually request IT to allow me the permission to get this, and they had to release it. But so let's say I'm at work and I'm applying to do a talk somewhere and they say, well, we need copies of your licensure and your certification. My office manager has it, she's out of the office for a week on vacation. So if I keep it up in the cloud, it's just a lot easier for me to just be able to, excuse me, uh access it and send it along. Excuse me.

Christopher Gleason 12:12

Love that. Absolutely. That's really good. All right. So now, so now let's look at at um updating. Do you two have any um tips or tricks as far as updating your licensure?

Jason Gleason 12:28

Oh, updating, you know, updating licensure, again, it's it's all about that file that we've already talked about. Have all your stuff ready to go. And updating your or renewing your licensure or updating it, either of those, um, especially renewals, like one year, I almost nearly um expired on my license. You never ever ever want to do that because that's a hard process to get back on. But the most licensing organizations in your state will send you a little postcard in the mail or an email. Look out for those, but actually put it on your calendar in your phone. Even if your license is not due for renewal for another two years, put it in your phone today so you never forget that. Because if you miss those important uh reminders and you you lapse in your license, that means no job. You can't practice. So I would say that. And then for NPI numbers, because that's a whole other beast, right? NPI numbers, same thing there. Um, you know, it there's kind of a myth out there that NPI numbers are secure, but they're not. NPI numbers are not secure. If you Googled Jason Gleason or Christopher Gleason or Vanessa here, um if you Googled any of us and put NPI behind it, our NPI number would come right up on Dr. Google, so to speak. So they're not very secure out there, but it's important you keep everything updated license, DEA, NPI numbers, and just stay on task and put little reminders in your phone. Vanessa, what tips would you be interested in sharing on that?

Vanessa Pomarico 13:46

I I would echo everything that you just said, Jason, but I'm gonna tell you a lesson that I learned in the last week. So I'm sitting at my desk documenting on a patient, my cell phone rings. Now I don't carry my cell phone, you know, into patient exam rooms, and I'm looking at it and I recognize a patient's name coming up on my cell phone. Well, come to find out, when I applied for my NPI and my DEA, I had used my home address and my home phone number. My cell phone is now out there for everyone to see. So I actually had to call our IT department to say, I'm having, I couldn't understand why some patients were texting me and I'm thinking, how did they get my home, my cell phone? And come to find out it was traced back to my original application for my MPI number. So they actually had to do a sweep of the internet and it's they're not happy about it. Um but that's just something to think about it to make sure that you put your office phone number there. If you if you change employment, then you can just change the NPI website and just update your phone number. But by all costs, unless you don't mind patients calling you on Saturday night at nine o'clock, um, you know, make just understand that your personal information is tied to your NPI number and your licensure. And if that's out on the internet, so is all your personal information.

Jason Gleason 15:10

Such a good point and a safety issue. I had one colleague, a physician colleague, that actually a patient who was suicidal showed up at his house on his porch and his child answered the door. I mean, horrific things like that. Big safety issue. So, Vanessa, I love the points you brought up to really protect your private information. Plus, you do not want your phone number written on any bathroom stalls across the country, right? So, yeah. So keep that stuff private, Christopher.

Christopher Gleason 15:36

Um the to Vanessa's point, when I initially signed up for my NPI, I did the same thing, Vanessa. I put my home address on it and my my home phone number and had to later go back and you know change everything to the business address for the for my practice at the time. So it is very, very important to make sure that you do that ahead of time. Um, so just a couple of tips regarding NPI. I want you all to remember that NPI is free. We can apply online through the National Plan and Provider Enumeration System or the NPPES. You will use the centers for Medicare and Medicaid Services, CMS, identity and access, and you can uh do the INA login. Things to remember have your details ready: your legal name, your social security number, your date of birth, mailing and practice address, your taxonomy number, and your license info. Now, the taxonomy, I really want to touch on this for a little bit because it's very important that you choose the correct taxonomy. So when you're looking at that, what the taxonomy is, is essentially it's your specialty, whether your family practice, your emergency medicine, um, acute care, things of that nature, when you're going into that NPI website, make sure that you choose the correct taxonomy because that's what's going to be applied to your NPI. And you want to make sure to keep it consistent with credentialing and uh payer enrollment as well. And if you have any life changes, make sure make sure to update that NPI promptly. You know, like Vanessa and I were talking about earlier, make it so important to change your address in the in the NPI system. And if you change practices, it's very important to make sure that you update all of that information as well. So let's look at some security basics. Make sure to have a strong and unique password. Um, never share any of your logins, watch for suspicious emails. You know, and to Jason's point earlier, having that dedicated professional email can can kind of really help uh in that regard.

Jason Gleason 17:25

You know, on that, Christopher, one tip to share with our friends and colleagues out there uh phishing scams are out there like crazy now, and they are so sophisticated, and many of them look absolutely legit. Like they'll even take logos, created them from like state organizations or licensing boards or whatever, and they'll look totally legit. So, one tip that I've that I'm passing on to you that I learned is that if you get an email and it's like, this doesn't seem right, right? Because they would never ask this over an email. I'd usually approach them and share this information. They wouldn't ask for it over an email, is click on the email that it's from and it'll look bogus. It'll look totally bogus. It won't be some dot org email or something that looks legit, it'll be totally bogus. And often it's overseas. And here's what, if you get screwed, if you get screwed in this process and divulge some information, sometimes you can never get that back. You can never get that back because it's sometimes a third world country. Somebody living out there is making a lot of money by doing phishing scams and selling that information. So just a tip.

Christopher Gleason 18:22

The another quick tip too is do a self-audit. You know, search your NPI number, see, see what comes up. Look at look at the NPI registry. You know, go into your account on the NPI registry, make sure that all your information is correct. All right. Vanessa and Jason, any tips or guidance on applying for and maintaining your DEA registration, Vanessa?

Vanessa Pomarico 18:44

So, you know, negotiate with your employer to pay for it. It's not cheap. It's $888 every three years on top of if your state requires it. Now, I know in Connecticut our our um our license, uh, our state um license for that is I think $40 for two years or something. It's very it's a nominal fee. But negotiate with your employer to make sure that they pay for your DEA registration, both state and federal. It's an expectation of your job, and it should not become a personal expense for you. What do you think, Jason?

Jason Gleason 19:20

Oh, I agree a thousand percent, right? It's all part of our job, and employers should pay for it. Sometimes they don't, though. So when you sit for your interview and that awkward time at the end of the interview where they ask you, do you have any questions for us? And your mind is blown, you're fried, you're frazzled, you just want to get out of there. So you ask ask something stupid like, what are the hours of operation? Can you tell me what time we get out of here every day? You know, something generic like that. Go after these things you really need to know. Like, do you guys pay for DEA? Do you pay for my DEA license? And if they say no, we don't, that might be one of your red lines. You know, well, you're gonna have to pay for it, otherwise, I'm not taking the job. And don't settle for less, because NPs and nurses, we tend to do that. We settle for less and we're worth so much more. So remember that, see it and be it. Ask for what you want. The other piece of advice I would have, Vanessa, I'm so glad you brought this up about employers paying for it. You know, at the VA where Christopher and I work in primary care, um, I used to pay the $880 every three years. We'll talk about a chunk of change, right? That's hard to come up with, especially these days where everything's so expensive. And so um so instead of paying that for yourself, the VA will actually uh bring you in under a pharmacy DEA number for the VA of the organization. So ask about that too. If you have a federal organization you're working with or a larger organization, can my DEA number be brought in underneath the organization? Because the organization has a DEA number. The caveat to that, and this is so important because you can get yourself in big trouble with this. If if, for example, I go to the VA and I and I am in in the real world, I actually am under their DEA. I cannot go and set up a moonlighting operation and writing scripts for weight loss medications at night to hundreds of people under that DEA or whatever medication I'm ordering. It's for controlled substances, obviously, but but yeah, you can only use that DEA number for that practice, that federal agency. Do not use it for private use because you get in big trouble. But uh, but yeah, those are the pieces of information I would share. Christopher.

Christopher Gleason 21:18

So we talked about the DEA and having and potentially having those controlled substance agreements. What we haven't talked about is when do you need it? So any role that prescribes, administers, or handles controlled substances, and that is schedules two through five. And per our scope and uh state roles, any any one of those um needs a DEA number to prescribe. The um also before we apply, make sure to have an active state license and required state controlled substance permit in hand, which is you know kind of touches on what Vanessa was saying earlier. And I believe in Montana as well, we have to if you're applying for the state of Montana in the state of Montana, you have to have a controlled substance agreement with the state as well. So we've talked about why you need it. Let's look at how to apply. You can complete the online application through the DEA or the diversion control division and select the correct schedules and practice address. That is crucial because you want to make sure that you can prescribe for what you need to prescribe for or the schedules that you need to prescribe for. Cost and renewal. As of 2025, most individual practice registrations are at $888, which was just what we talked about. And that's for a three-year term. And that can be very, very pricey, pricey. And it does renew every three years. And start early, about 45 days before you need that DEA or before that DEA expires. Make sure to get that information into them.

Jason Gleason 22:38

That's so important. Can you imagine running out of your DE and having to go to a colleague? Hey, would you mind writing my scripts for the next month? Because I slacked off and I didn't get my DEA. Nobody's going to do that for you. So often what that'll mean is employers will put you on leave until you get your DEA, or you know, you may not work for them anymore. So make sure you're up to date on this stuff.

Christopher Gleason 22:56

Exactly. So another thing to remember too is the multi-state reality. So DEA registration is tied to a state and practice location. If you prescribe in another state, you typically need to comply with that state's requirements too. Also looking at training, uh the requirement, the MATE Act requires, or M A T E, excuse me, act requires a one-time, eight-hour training at a station on opiates or substance use disorder care for new or renewing registrants. And that was effective June 27, 2023. Vanessa, I was, I believe you were going to bring up a point.

Vanessa Pomarico 23:33

Oh, no, I was just going to say something about the DEA piece of it. You know, if you if you have to ask one of your um colleagues to write a prescription for you, then that becomes what we call incident two billing. It's really against the law for let's say you let yours lapse and you came to me and said, Hey, you know, I forgot, can you write out this prescription for, you know, some annex for my patient? Without me seeing the patient, that now becomes a sticking point because now I have to go in and see the patient legally and bill it out as an incident to billing in order for me to sign that prescription legally.

Jason Gleason 24:11

Great point. And why many of your colleagues will say no because of that. Yeah, such a bad point.

Christopher Gleason 24:18

So we've touched on licensure, we've touched on the uh DEA um requirements. Let's look at APRN compacts and cross-state practice realities.

Jason Gleason 24:26

Such a hot topic, APRN compacts.

Vanessa Pomarico 24:30

I'm very excited. Connecticut just got compact.

Jason Gleason 24:34

What's that?

Vanessa Pomarico 24:34

I said I'm very excited. Connecticut just received compact licensure.

Jason Gleason 24:39

They did. Wow.

Vanessa Pomarico 24:40

Yes, yes. We were really one of the, we were really behind the times, but we just got it in November, October.

Christopher Gleason 24:47

That's interesting. So touching on that, Vanessa, what are your thoughts on the compact?

Vanessa Pomarico 24:50

You know, I think it's a great idea, especially because of all of the telehealth that we're doing and uh people who are taking jobs that are doing a lot of telehealth and it's nationally. It's so, I think it's just great to have it. I know, you know, years ago, um, right in the post-Katrina, when Katrina hurricane hit, I was volunteering at a clinic in Mississippi and I had to reapply for all of my licensure and pay for everything separately, even as a volunteer, because we didn't have compact licensure back then. So I think it's really important, especially like I said, now that we're doing so much telehealth or even people that are working for national organizations that can, you know, are gonna work, you know, in New England, you can go from Connecticut to Massachusetts to Rhode Island to New York very, very quickly. Um, but if you don't have that compact licensure, then that's an extra added expense if you have to go across the lines to practice. What about you, Jason? What do you think?

Jason Gleason 25:50

You know, the compact for me, I I absolutely agree with you 100%. Great, great idea. And it simplifies things, it reduces cost, right? The one concern we had in Montana where this came up as an issue just this last year in our legislative session is that it it just is not ready yet for us to jump on board with it completely. And that's tough for a rural state. And many of you out there that are listening or watching, you live in rural states, right? So it'd be great to have a compact where you could maybe fly somewhere over a weekend and do some locums work in a different state and go back home. And it's such a such an asset and resource for those areas where they're really underserved. They don't have providers. So so there are so many positive things to it. Some of the the downside to the compact is, I would say, and why there's some opposition to it in our state, totally support the idea. In theory, it's wonderful, and and we'll get there. We'll get there. But in Montana and other states, we just felt like the compact wasn't quite ready yet with some of the stipulations. And some national organizations like A and P, for example, I know that they've talked about and it's on their website, uh, reasons why they don't feel like the compact is quite ready yet for everybody to jump on board, but they're still working on it. And that's what it's about working out the details, getting those fine detailed points taken care of and settled so it so it'll be a good uh compact for everybody. And hopefully more states will jump on board when that's there. But in Montana, for example, uh they voted that down in our state. But but it it's back and forth, right? So it's a great idea, but again, it it does require some work in some areas before it's really gonna take off. But I I am so excited for the day where we have a compact that covers our entire country. Won't that be nice? But it has to be favorable to NP practice, it has to be supportive of our practice. And in Montana, we felt like it just wasn't there yet.

Christopher Gleason 27:36

Um I agree. I I'm looking forward to the day that we won't have to, or we'll have that compact that's across the country and we won't have to necessarily worry about where our licensure is excellent. Um so we looked at what a compact uh to define a compact. So it's a multi-state licensure agreement where your home state license grants you practice and privileges in other member states. So the A APRN compact, which we just spoke about, uh takes effect after seven states enacted it as of twenty twenty-five. So four states have enacted. Um both Delaware Delaware, North Dakota, South Dakota, and Utah have enacted.

Jason Gleason 28:16

And Vanessa, you said your state just enacted it, right? That's five. Yeah, yeah.

Christopher Gleason 28:20

So until it is active, you generally need an APR and license in the state where the patient is physically located at. That's at the time of visit. Telehealth reality, number one, always confirm and document a patient location each visit. Um speaking of telehealth, so we're talking about practicing across state lines. And when you're using when you're doing telehealth, it's very, very important to make sure that your license covers, you know, you to you to be practicing telehealth in those different states.

Jason Gleason 28:48

Um, and that brings up a good point because how many of you out there are setting up because it's a hot item, right? And not just from a business model, but you want to help people through their obesity crisis, which our country and the world is in right now. But there's so many great tools and resources now. So NPs are creating and launching these practices, these weight loss clinics that are multi-state, you know, a lot of it's telehealth and helping a lot of people, but what a logistic nightmare without a compact that covers our entire country. Because if you don't have a compact, that means you have licensure and all those issues that go with that in every single state where you're taking care of those patients. And the state law follows the location of the patient that you're treating. So it can be quite costly. So some of you out there are dreaming, well, I'm gonna start a telehealth business for obesity. That's great, but get ready because there's a lot of logistics involved in that. And you definitely want to play by the book on that stuff and never ever um get off track with that because it could mean big legal and liability issues for you. So yeah.

Vanessa Pomarico 29:46

And psychiatry, psychiatry. Oh, true.

Jason Gleason 29:49

Absolutely.

Vanessa Pomarico 29:50

You know how many of our mental health, psychiatric mental health NP colleagues are now doing telehealth. And even we noticed a huge deficit in this during the pandemic. So the compact licensure is really going to change the landscape of practice on a myriad of levels. Like you said, obesity medicine, psychiatry, and so many other areas where uh nurse practitioners then can extend their practice outside of the state where the patient happens to be.

Christopher Gleason 30:20

Very important, very important. So, talking about telehealth, what is the reality of actually uh using telehealth in our practices? Number one, we always have to confirm and document patient location each visit. As we stated before, state laws follow the patient. Um, number two, let's look at scope and practice prescriptive authority. They still vary by state, including controlled substances. So you have to make sure that your license will cover uh practice in that difference in another state. Um the prescription drug monitoring program, this is huge. For those that don't know, the PDMP of the prescription drug monitoring program, it looks across state lines at the um prescribing practices for your patients, looking at do they have opiate prescriptions in other states? Especially if you have um patients that you're concerned with that they're opioid-seeking or or uh med-seeking, you can actually look across state lines and say, okay, this provider in, you know, let's say for instance, in in uh Vanessa's case, this uh provider in New York prescribed uh Suboxone to my my patient from Connecticut. And Vanessa can look at that and say, okay, they got opiates from from New York and now they're looking at opiates for me. So it's a very, very important tool to utilize. Um I know I utilized it a lot when I was doing uh my substance abuse uh practice.

Jason Gleason 31:36

Well, and Vanessa, I don't know about your clinic, but at the VA, the PDMP, if I prescribe an opiate or any controlled substance, if that PDMP is not in there or EHR, the quality, the QI checks they do, they they will wrap on you, right? They will come down on you. So you have to know about the PDMP and how to access that. And at the VA, they even require us to go to that and check it for any controlled substance, including opiates, and uh and copy the PDMP and put it into a note in the chart so it's there for them. So and it's safe practice. We want to do those things, right? So be on the lookout for that. Is that your case, Stu, Vanessa, in your state?

Vanessa Pomarico 32:10

One of the nice things that they did because it was becoming so cumbersome, especially as you know, Jason, you work in primary care. You know, not that I write for a lot of controlled substances, but even things like Larica, you know, or somebody who's taking Fioracet or Fiorinol, you know, or a little bit of Xanax if somebody's traveling, you know, those types of things. Uh so what they did was they actually built in a link because we were all complaining. So now if I'm prescribing something, a hard stop comes up. I have to click on it, it goes right to the Connecticut PMP site. I'm able to look through it, verify it, and then it brings me right back to my note. It's been a huge time saver.

Jason Gleason 32:50

Outstanding. Because it takes time. And when those patients come in, you have 15 minutes with them. You don't have time to sit there. That's where you end up being there late at night until eight o'clock at night some nights doing PDMP reports and that stuff. So I love that. Um, you know what I'm so grateful for in our state, and hopefully most other states will be doing this too. They add even medications that have a high dependency uh potential to them, like gabapentin, for example, right? That's been added to the PDMP too. Because I'll tell you what, I run into so many patients that have dependency issues with gabapentin and they're abusing it. And before they added that, there was no way for me to track are they getting it from other sources, but now there is. So hopefully most states are moving in that direction as well.

Christopher Gleason 33:29

Great points, great points. So let's look at payer rules and how they can differ. So you're looking at the modality, um, the documentation, originating site, and the the consent requirements all can affect payer rules. So one little practical tip I would impart is to build a multi-state renewal calendar. If you if you practice in multiple states, you want to make sure that you have the dates for all the licenses, license renewals, your controlled substance permit renewals, your DEA uh renewals, looking at continued education requirements, and make sure that your attestations are up to date as well.

Jason Gleason 34:08

So how would you uh uh Vanessa and Christopher, how would you create that that uh spreadsheet or calendar? What comes to my mind is like an Excel spreadsheet. The calendar in your phone, I think things can get lost sometimes, but when you're talking about a big thing like this that can impact your license and liability issues, I would uh an Excel spreadsheet would come to my mind, something you can look at and update on a regular basis. Do you two of you have any ideas on that? What else you'd recommend?

Christopher Gleason 34:33

I think I'd also look at doing um earlier we talked about having a a folder specific for your licensure requirements. I think if you have, if you're practicing in multiple states, having different folders for each state that you're practicing in could be a benefit. Because that way you have all of the information you need in one location. And I agree, having an Excel spreadsheet, something that you can have the dates on it and look, you know, as a quick reference and say, hey, I need to make sure that my my license is renewed. I need to make sure that my my CEs are all up to date. Vanessa, what do you think?

Vanessa Pomarico 35:02

That's exactly what I what I do is um being licensed, excuse me, in Connecticut as well as Mississippi, I have two entirely different files. And I do keep a spreadsheet, but one of the other things I do is I actually put a reminder on my phone so that a reminder will pop up 45 days. I usually start a couple of months before. Um, so it pops up. So I get everything together, make sure everything is updated, um, and then I start the the um the process early enough so that I'm not waiting until the last minute for anything to expire.

Christopher Gleason 35:35

Nice. Absolutely, absolutely. Great points, great points. And um, here's some resources that we wanted to share with you. You'll see them on the show notes, and they are on the screen in front of you. So no need to uh write them down.

Jason Gleason 35:48

Those are such great resources. I'm so glad you shared that, Chris, because people out there, I know I was lost. Well, where do I find this information, right? So I'm so glad it's in our show notes and on the screen in front of you. That's really good. Absolutely.

Vanessa Pomarico 36:01

So important.

Christopher Gleason 36:02

Very much so. All right, so we had a great discussion on many important topics today. Let's move over to our fact or fiction segment to help our listeners and each other push the fiction aside to find the facts. All right. First up, you can apply for your NPI number before you start your first job. Vanessa fact or fiction.

Vanessa Pomarico 36:22

Fact.

Christopher Gleason 36:25

Absolutely. Next one. Your NPI should never be shared with an employer. Jason fact or fiction.

Jason Gleason 36:33

Fiction, yes. They want to know what your NPI number is. Absolutely. As long as you don't share your personal home phone number or address, right? Yeah. Right. Of course they're going to want to know that under emergencies and they keep that confidential. But yeah. Employers will want to know.

Christopher Gleason 36:47

All right. And uh some roles require a DEA registration, some do not. Vanessa fact or fiction?

Vanessa Pomarico 36:54

Fact. However, there's a caveat to that. It's a good idea to have your DEA because it really does demonstrate that you're safe in clinical practice. And it also alleviates the need, as we mentioned earlier, to have another prescriber have to prescribe something like Xanax or Ritalin or Lyrica. And then again, it becomes a completely different type of visit, again, because you have to do that incident too.

Christopher Gleason 37:21

Absolutely, absolutely. All right. So is the APRN compact active in all 50 states right now, Jason?

Jason Gleason 37:28

I would say that's fiction. Yeah, incorrect. But here's the deal. I cannot wait. And Vanessa and Christopher, I'm sure you can't wait either when all 50 states are. But here's the deal with the compact, because there's a big debate, and you know, people demonize the other side, right? In debates all the time. That's how we do things these days. But don't do that. Yeah, don't do that. What I try to do is respect other people's opinion on the compact. I personally believe it's not ready yet for all 50 states because we don't want to shortchange ourselves as NPs. But it's going to be amazing when it did it does happen. But respect the other side too. And I certainly do that. But uh let's continue to build consensus, work together, and we'll get there to those 50 states. But that right now is fiction, unfortunately.

Christopher Gleason 38:09

That is very true. All right, now to the favorite part of our show, interacting with you, our friends and colleagues. Here are some of the questions that you've sent in to us for us to answer. And remember to always email your comments, clinical tips, or questions to nplaunchad@fhea.com. First up, which application process tripped you up the most? Licensure, NPI, DEA, or credentialing? Jason?

Jason Gleason 38:36

Yeah, I'd say all the above. Just the time involved. I mean, be prepared for weeks, if not months, to work through that process. So start early and like Vanessa said, stay organized. Christopher, I think you you tied on to that too. But yeah, just stay organized, be easy on yourself, but don't chillax, stay on schedule, but be be expecting a big time commitment in that. Absolutely.

Vanessa Pomarico 38:56

And I also have to, well, I just have to say, Jason, you might remember this when we became nurse practitioners. Nothing was online. And I remember my first job. My first job, the office manager came in with this stack of paperwork, dumped it on my desk, gave me a pen, and said, good luck. I'll see you in a few hours. And for every separate payer, I had to have a separate application. It took me hours to do it all. Now it's much more streamlined in terms of credentialing. But you're right. You know, I think it's overwhelming as new nurse practitioners when we've never had to worry about anything except paying for our end license every year. But when we have to now think about all of our licensures, our certifications, our DEA, and the credentialing, it can become overwhelming. Just take a breath, it gets done, and just in, you know, have your billing office help you with it. That's really my biggest pearl.

Jason Gleason 39:53

Well, two points to add on to that. Number one, thanks for triggering my trauma from those days of paperwork. People have no idea how spoiled they are today, right? Yeah. Yeah. But um, but secondly, um, you brought it up. Reach out to your clinic manager and ask them, do you have somebody in your medical staff office? Because usually it's a medical staff office that deals with medical uh personnel issues or NP personnel issues. And often organizations, especially if they're larger, they will have somebody do all this work for you and they'll just say, hey, sign here. And then you review it, of course, for accuracy. But that that that would be the ideal situation where I I've worked as an NP at a large uh healthcore organization in a hospital medical system, and they had an entire department that handled that stuff because they're good at it, right? Otherwise, you're right, Vanessa. It's it you want to pull your hair out and all the time it takes to fill out all those forms online or the paper which you triggered me for. So Christopher, how about you?

Christopher Gleason 40:46

Great points for the for both of you. So let's look at another question. This this question kind of um refers back to our telehealth section that we spoke on earlier. Can you see a patient located in another state if you're not licensed there? Vanessa, what are your thoughts?

Vanessa Pomarico 41:01

So this is a real dicey question because as we know, um, after the pandemic, all of the telehealth requirements started to change. And things changed very drastically, and now we're kind of going like three to six months at a time. So it really all depends on what state you're practicing in and what state the patient is in. So we had reciprocity between Connecticut and Florida. I'm just gonna use that as an example because we had so many people from Connecticut, we call them the snowbirds. You know, as soon as it gets below 60, they take off to Florida. And we were able to do telehealth with them uh for, you know, the several years as a result. If my patient decides to go skiing in Colorado, I'm not able to do telehealth with them because it's not part of the practice area. How about you, Jason?

Jason Gleason 41:53

Yeah, same thing. It's it's complex. It's not as cut and dry as it seems like, but always uh go on the the side of safety, right? And protecting your license and know what each state individually is requiring for this. But in general, I would say we're not licensed to treat people in other states, especially if they have residency, like and especially the snowbirds, those are complicated ones for me. Vanessa, I always run into that and I'm double checking things because they have two addresses and it's like, uh, you're kind of walking the fine lines. So definitely know what both states, the one they're residing in, whether it's temporarily throughout the year or they moved or they're on vacation, but know know the rules in each state because you definitely don't want to go outside the boundaries.

Christopher Gleason 42:32

Right. Thank you for some fantastic questions, and please keep them coming in. Um, as we stated earlier, our email address will be in the show notes, so no need to write it down. That's a gonna wrap up. What's our landing checklist for this episode? So here are your three take-home tips for our time together today. If you haven't done so, create your N NPI account, build a one-page credentials sheet, make a single licensure launch folder. And as we spoke on earlier, if you have a licensure in multiple states, making multiple folders can be of benefit for that too. Also, including in that folder, make sure to include your uh passwords, uh checklists, anything that you may need so you're never scrambling when it's time for licensure. All right. So, what's your homework for the week or your weekly NP practice project? As we spoke on earlier, start your NPI DEA licensure as soon as possible. Checklist and bookmark your state board pages, making sure that you have access to those readily available.

Jason Gleason 43:35

That's easy. Is that all they get this week, Chris? Is one thing? Yes, exactly. Last week when I moderated, I gave them several. Just one thing this week.

Vanessa Pomarico 43:42

Wow. Yeah, but remember, they're done with school. Oh, I see. You don't need to give them more work.

Jason Gleason 43:47

Who's your favorite host now? Right here, right? Yeah, I just gave you one thing to work on. Come on.

Christopher Gleason 43:54

All right. Thank you, everybody, for your time this week. We are honored, all three of us are honored to connect. With you and hope you have a great, amazing week. And we can't wait to see you again. And please, please do these three simple actions that will help us grow this podcast and broaden its reach. Please drop a five-star rating, hit the follow button, tap subscribe, and most importantly, share this podcast with your colleagues, family, and friends so we can continue to build a community of friends, looking out for supporting and strengthening each other. As we sign off, stay tuned for our next episode, Credentialing and Privileging 101. Have a great day, friends.

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