can an intern prescribe?

[jonnylingo]

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This has been touched on before, often hitting the ethics of prescribing self/family/friends. I have a question about the legalities of residents prescribing. Narcs go without saying, but can one prescribe chronic meds for family? (inhalers, OCPs)?

Say a brother-in-law's wife needs script for OCPs that she has been taking for a while, but because of insurance transition, they must pay massive co-pay for one script. From out of state, he calls you, the new family doc, and asks for one script. Can you write it?

 

[Jolina]

In my hospital only to my patients (at least that's what I was told).

 

[docB]

Flame ******ant: I'm addressing legalities only here as that's what the OP asked about.

Do you have a medical license? If not then clearly no. If it's a training license (one issued just for your work as a resident) then it might get filled but you might get fired if your instution finds out. If this is to be filled in a different state then it gets even sticker. The other state might not recognize your license or your training license.

Now, one problem with prescribing when you don't bill, which presumable you wouldn't, is that it is viewed by CMS as fraud since you're obligated to give them the best deal. If you are only licensed as a trainee you might be shielded from this as you don't bill anyone but it would certainly be unwelcome scrutiny.

 

[3dtp]

Flame ******ant: I'm addressing legalities only here as that's what the OP asked about.

Do you have a medical license? If not then clearly no. If it's a training license (one issued just for your work as a resident) then it might get filled but you might get fired if your instution finds out. If this is to be filled in a different state then it gets even sticker. The other state might not recognize your license or your training license.

Now, one problem with prescribing when you don't bill, which presumable you wouldn't, is that it is viewed by CMS as fraud since you're obligated to give them the best deal. If you are only licensed as a trainee you might be shielded from this as you don't bill anyone but it would certainly be unwelcome scrutiny.

...Only if you are a participating provider. If not, CMS has no say in what you do.

The licensure part is correct. In those states that require it, generally, that license can only be used at your training institution.. Once you get an unrestricted license you then may write Rx, including narcotics if you have a DEA number. But, remember that you must meet the standards of care, which means you have a physician patient relationship.

 

[Miami_med]

I am pretty sure that you can prescribe if you don't bill at all (after full licensure). I think it becomes a problem if you try to bill less or bill insurance without billing the patient. There are exceptions to the "best deal," I'm pretty sure. If you volunteer in a homeless clinic and write a prescription, I don't think anyone gets mad.

 

[Bring It On]

a doctor got his license suspended for writing a script for an inhaler for a friend....😀...be careful!!

 

[docB]

...Only if you are a participating provider. If not, CMS has no say in what you do.

The vast majority of docs, and all EPs, are CMS providers. As much as I love the idea of going it on your own and giving the government the finger the docs who opt out of CMS are a sideline in a few specialties. Plastics, derm and the boutique guys are about the only ones who can make a go of it.

 

[docB]

I am pretty sure that you can prescribe if you don't bill at all (after full licensure). I think it becomes a problem if you try to bill less or bill insurance without billing the patient. There are exceptions to the "best deal," I'm pretty sure. If you volunteer in a homeless clinic and write a prescription, I don't think anyone gets mad.

The other thing they can get you on is that you're required to have a record of the patient visit. If you write a script for a friend you won't have a record. If you do have a record it won't be stored in a HIPAA compliant records repository. They'll get you one way or the other if you get on the radar.

 

[Miami_med]

The other thing they can get you on is that you're required to have a record of the patient visit. If you write a script for a friend you won't have a record. If you do have a record it won't be stored in a HIPAA compliant records repository. They'll get you one way or the other if you get on the radar.

If the friend doesn't complain, and no one wrongly attains the record of the visit, are you sure that HIPPA can be used against you? Of course, this would speak to making sure that your friends are actually friends.

 

[Smurfette]

...Only if you are a participating provider. If not, CMS has no say in what you do.

The licensure part is correct. In those states that require it, generally, that license can only be used at your training institution.. Once you get an unrestricted license you then may write Rx, including narcotics if you have a DEA number. But, remember that you must meet the standards of care, which means you have a physician patient relationship.

What you can prescribe as an intern varies by state and institution. Almost invariably, you can prescribe almost anything (except "restricted" items like super big gun abx which require ID approval, etc.) to inpatients in your institution. As an outpatient, it varies by state law and you license.

When I was an intern and had only a training license, my institution provided me with a training DEA. Therefore, I could prescribe narcs for my patients without having someone with a "real" DEA sign for it. The patient can fill it anywhere in my state without issue. Legally, in my state (as in most states) I cannot prescribe myself or family members narcotics, but can prescribe other things to myself or them with caution (Z-packs, OCPs, inhalers, etc.). However, that is something you need to use your own discretion with how to handle it. Without getting into the moral debate on prescribing for people who are not officially your patients (that's another thread in itself), continually prescribing items for family members *can* lead to further inquiries or insurance billing issues without documentation of a physical exam.

 

[3dtp]

What you can prescribe as an intern varies by state and institution. Almost invariably, you can prescribe almost anything (except "restricted" items like super big gun abx which require ID approval, etc.) to inpatients in your institution. As an outpatient, it varies by state law and you license.

When I was an intern and had only a training license, my institution provided me with a training DEA. Therefore, I could prescribe narcs for my patients without having someone with a "real" DEA sign for it. The patient can fill it anywhere in my state without issue. Legally, in my state (as in most states) I cannot prescribe myself or family members narcotics, but can prescribe other things to myself or them with caution (Z-packs, OCPs, inhalers, etc.). However, that is something you need to use your own discretion with how to handle it. Without getting into the moral debate on prescribing for people who are not officially your patients (that's another thread in itself), continually prescribing items for family members *can* lead to further inquiries or insurance billing issues without documentation of a physical exam.

I'm pretty sure that's what I said. That being said, in three states I have practiced, (only one with a training license, to be sure) a training license was only good within the supervision of the training institution.

This is the OP's problem. s/He can, under the terms of his license only practice under the supervision of his program. It is likely that his family/friends are not patients of that institution and not in clinic there. Ergo, if he prescribes outside of supervision, he is in violation of the training license. Not somewhere I would have gone, personally.

Once the resident does qualify and obtains a permanent and unrestricted medical license, and he want to write Rx for his friends and neighbors, including the "big gun" antibiotics, he is free to do so. The requirement for ID is institution dependent and will vary by institution, even within states.

All training institutions have a DEA number for its residents to use. The DEA requires a permanent and unrestricted license to issue the DEA number. It cannot be obtained by interns who cannot get a permanent unrestricted license. Many states now require two years of residency before issuing the licence.

I agree with Doc-B that CMS non-participators are rare, but residents are non-participating, by definition. CMS is bribing a training program to put up with them (at least that's what the institutions would have us believe). Interns cannot legally bill Medicare.

Records must be kept, but HIPAA gives wide latitude to the format, unless you are billing someone. The information must be protected, but if you have a yellow pad in a locked drawer that documents the visit, you have a medical record. And you must keep a record to document the need for the Rx.

 

[Tired]

I'm pretty sure that's what I said. That being said, in three states I have practiced, (only one with a training license, to be sure) a training license was only good within the supervision of the training institution.

This is the OP's problem. s/He can, under the terms of his license only practice under the supervision of his program. It is likely that his family/friends are not patients of that institution and not in clinic there. Ergo, if he prescribes outside of supervision, he is in violation of the training license. Not somewhere I would have gone, personally.

I suspect you're confusing the policies of the institution issuing the training license with the law surrounding that license. For example, I am frequently called by clinic nurses to write prescriptions for patients who have called in for med refills. There is no record of any visit (because there was none), and I have never personally seen the patients, yet this is apparently totally kosher.

 

[sdn1977]

If the friend doesn't complain, and no one wrongly attains the record of the visit, are you sure that HIPPA can be used against you? Of course, this would speak to making sure that your friends are actually friends.

Hmmmm.....no. Complaints can come from many sources. If an insurance company audits a pharmacy, which they do frequently - they will track who the rx was for, who wrote it, the days supply, etc...

Then - they go find the record from the prescriber - my husband has been audited multiple times.

Yes - there needs to be a pt relationship & you can keep those records as loosely as you care to. But...it can & is tracked.

Now - if its cash only....a different story. No one will complain, but the last cash rx I filled was for a doctor-shopping vicodin chaser. Would that be your friend??

 

[sdn1977]

I'm pretty sure that's what I said. That being said, in three states I have practiced, (only one with a training license, to be sure) a training license was only good within the supervision of the training institution.

This is the OP's problem. s/He can, under the terms of his license only practice under the supervision of his program. It is likely that his family/friends are not patients of that institution and not in clinic there. Ergo, if he prescribes outside of supervision, he is in violation of the training license. Not somewhere I would have gone, personally.

Once the resident does qualify and obtains a permanent and unrestricted medical license, and he want to write Rx for his friends and neighbors, including the "big gun" antibiotics, he is free to do so. The requirement for ID is institution dependent and will vary by institution, even within states.

All training institutions have a DEA number for its residents to use. The DEA requires a permanent and unrestricted license to issue the DEA number. It cannot be obtained by interns who cannot get a permanent unrestricted license. Many states now require two years of residency before issuing the licence.

I agree with Doc-B that CMS non-participators are rare, but residents are non-participating, by definition. CMS is bribing a training program to put up with them (at least that's what the institutions would have us believe). Interns cannot legally bill Medicare.

Records must be kept, but HIPAA gives wide latitude to the format, unless you are billing someone. The information must be protected, but if you have a yellow pad in a locked drawer that documents the visit, you have a medical record. And you must keep a record to document the need for the Rx.

You can no longer use an institutional DEA in CA. You must have your own for controlled substances for rxs written for non-hospital pts.

We are moving to NPI's - as of Nov (the last update), so DEA's will only be required for controlled drugs. Gotta wait until that happens.

For cash, no NPI or DEA is required - just a state license.

 

[Mman]

The other thing they can get you on is that you're required to have a record of the patient visit. If you write a script for a friend you won't have a record. If you do have a record it won't be stored in a HIPAA compliant records repository. They'll get you one way or the other if you get on the radar.

I'm pretty sure HIPAA in terms of patient records and privacy stuff only applies to organizations that transmit patient information wirelessly. At least that's the way it used to be because I have an older relative with a practice that was completely exempt from anything relating to HIPAA because all their records were on paper.

 

[sdn1977]

I'm pretty sure HIPAA in terms of patient records and privacy stuff only applies to organizations that transmit patient information wirelessly. At least that's the way it used to be because I have an older relative with a practice that was completely exempt from anything relating to HIPAA because all their records were on paper.

Hmmmm - I don't get this. All my rxs are on paper of some sort. I have to keep them for 10 years (my vaccine records for the pts lifetime - we still haven't figured that out yet) even though they are all electronic as well.

But, HIPAA apples to all pt records - hard copies or electronic. My husband's dental charts are all on paper - only his X-rays are digital & they all fall under HIPAA regulations....and he needs a chart on every pt he treats. He has to make one for a pt he is covering when on call for a neighboring dentist if he gives advice or treatment, even if its just one visit or phone call. When transmitting for insurance reimbursement, the whole chart doesn't get sent, just the billing. But, the chart must be there for auditing when "they" come & "they" do come!

 

[docB]

I'm pretty sure HIPAA in terms of patient records and privacy stuff only applies to organizations that transmit patient information wirelessly. At least that's the way it used to be because I have an older relative with a practice that was completely exempt from anything relating to HIPAA because all their records were on paper.

No HIPAA applies to all "protected healthcare information" be it on paper, verbal or digital.