Scope of Services

Virtual Nurse Rx furnishes administrative support services only. We are not a health care provider. We do not provide medical care, nursing care, diagnosis, treatment, telehealth services, or clinical advice, and we do not establish any relationship with a client's patients other than as an administrative agent of the client. All clinical decisions and all clinical communications with patients remain the sole responsibility of the client's licensed providers.

Our personnel are medically trained, healthcare-educated professionals. Many are nurses or physicians educated and licensed outside the United States. Except where a specific individual is expressly identified in writing in an Order Form or Statement of Work as holding an active United States license, our personnel are not licensed to practice nursing or medicine in any United States jurisdiction and do not act in any licensed clinical capacity.

Where a United States licensed individual is assigned, that individual acts only within the scope of, and in the state or states covered by, that license, and only as expressly agreed in writing. Assignment of a licensed individual does not expand the scope of services.

Our personnel do not represent themselves to any patient, client, or third party as a Registered Nurse, a physician, a licensed clinician, or as holding any United States license or certification they do not hold.

• appointment scheduling, rescheduling, confirmation, reminder, waitlist, and cancellation management;
• insurance eligibility and benefits verification, coverage research, and preparation of patient cost estimates from payer data;
• prior authorization support, including assembling provider-supplied documentation, submitting requests, tracking status, and following up with payers;
• patient intake, including collection of demographic, insurance, and self-reported history information onto client forms;
• referral coordination, records requests, and closure of documentation loops;
• transcription, documentation formatting, and scribe support prepared for review, amendment, and signature by the client's provider;
• medical coding and billing support, including data entry, claim submission, denial follow-up, posting, and accounts receivable work;
• structured follow-up and aftercare calls conducted solely on scripts and forms approved in advance and in writing by the client's provider;
• reception, message taking, and message relay in accordance with the client's written Escalation Protocol;
• live chat and telephone support for scheduling and administrative inquiries;
• electronic health record data entry and practice management administrative tasks.

Our personnel do not perform, and clients agree not to direct our personnel to perform, any of the following:

• the practice of medicine or nursing in any form;
• telephone, electronic, or in person triage, symptom assessment, or any determination of the urgency or clinical significance of a patient's condition;
• medical advice, clinical patient education, or responses to clinical questions from patients;
• medication guidance of any kind, including dosage, timing, interactions, or side effects (we may route refill requests to the client's providers);
• prescribing, transmitting, or authorizing prescriptions;
• access to any state Prescription Drug Monitoring Program;
• communication or interpretation of laboratory, imaging, or diagnostic test results to patients;
• crisis assessment, crisis counseling, or risk evaluation (callers in crisis are connected to the client's on-call clinician or directed to emergency services under the Escalation Protocol);
• diagnosis, treatment planning, or determination of level of care;
• signing, finalizing, or closing clinical documentation;
• any task that applicable law reserves to a licensed professional in the jurisdiction where the patient is located.

Where a patient raises a matter within Section 4, our personnel collect information using client-approved scripts or forms without interpretation, route the matter under the Escalation Protocol, and relay the client's response verbatim with attribution to the client's provider. Our personnel do not answer follow-up questions that the client's response does not address, and return such questions to the client.

Clients maintain a current written Escalation Protocol identifying on-call personnel, order of contact, contact channels, response expectations, and instructions for emergency callers. We are not responsible for delays arising from an incomplete or out of date Escalation Protocol.

• provide and maintain a current written Escalation Protocol and approved scripts and forms;
• provide system access via individually named user accounts granting the minimum access necessary;
• notify us promptly of changes to systems, permissions, on-call personnel, or workflows;
• refrain from assigning tasks outside the Permitted Services without a written amendment or new Statement of Work;
• determine whether any payer agreement, government program, accreditation requirement, or state law restricts access to patient data by personnel located outside the United States, and notify us in writing before access is granted;
• retain responsibility for all clinical decisions, all billing and coding determinations submitted under client identifiers, and all supervision required of the client under applicable law.

Clients acknowledge that our personnel are administrative personnel and, except where expressly agreed in writing for a specifically identified licensed individual, do not constitute clinical staff for purposes of any Medicare, Medicaid, or commercial payer code that requires clinical staff time. Clients shall not count time spent by our personnel toward any time-based care management or other code requiring clinical staff time, and are solely responsible for the accuracy of all claims submitted under their identifiers. We make no representation regarding the billability or reimbursement of any service.

If a client requests a task described in Section 4, our personnel decline the request and escalate to a Team Lead, who works with the client to identify a compliant alternative. Declining such a request is not a breach or a service failure.

Engagements are month to month with a minimum of forty hours of service per role per month, terminable by either party on thirty days written notice. Changes to scope require a written amendment or a new Statement of Work signed by both parties.