Medical Assisting across State Lines

I recently received the following two questions:

1. Is a medical assistant permitted to cross state lines and work in two different states at the same time?
2. Are there any CMAs (AAMA) working as “traveling medical assistants,” similar to “traveling RNs”?

 

A medical assistant is permitted to work in two different states as long as the medical assistant is abiding by the medical assisting laws in both states, and meets any credentialing requirements in the two states.

There is nothing in the laws of any state that forbids a medical assistant from working for more than one employer.  If that is your definition of a “traveling medical assistant,” it is permissible for a CMA (AAMA) to work in in this capacity.

 

AAMA Submits Comments to HHS

The AAMA recently submitted comments concerning the proposed rule for the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive to the U.S. Department of Health and Human Services. What follows is the full text of those comments.

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Department of Health and Human Services
Centers for Medicare & Medicaid Services (CMS)
42 CFR Parts 414 and 495

File Code: CMS—5517—P

Federal Register, Vol. 81, No. 89, pages 28161—28686
Monday, May 9, 2016

Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models; Proposed Rule

The following comments are being submitted on behalf of the American Association of Medical Assistants (AAMA), the national organization representing the medical assisting profession at the federal and state levels, in regard to the above-captioned proposed rule.

I. Computerized Provider Order Entry (CPOE) and Protection of Patients; Excerpts from the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs Stage 3 Final Rule (October 16, 2015)

The American Association of Medical Assistants is in total agreement with the following excerpts from the “Medicare and Medicaid Programs; Electronic Health Record Incentive Programs—Stage 3 and Modifications to Meaningful Use in 2015 Through 2017; Final Rule” (80 FR 62762 through 62955), October 16, 2015:

(Page 62798, second column)

In the Stage 2 final rule (77 FR 53986) and in subsequent guidance in FAQ 9058, we explained for Stage 2 that a licensed health care provider or a medical staff person who is a credentialed medical assistant or is credentialed to and performs the duties equivalent to a credentialed medical assistant may enter orders. We maintain our position that medical staff must have at least a certain level of medical training in order to execute the related CDS [clinical decision support] for a CPOE order entry…

(Page 62839, second column)

…We believe CPOE and CDS duties should be considered clinical in nature, not clerical.  Therefore, CPOE and CDS duties, as noted, should be viewed in the same category as any other clinical task, which may only be performed by a qualified medical or clinical staff person.

In keeping with the above excerpts, it is the position of the AAMA that only appropriately credentialed medical assistants (in addition to licensed health care professionals) should be permitted to enter medication, laboratory, and diagnostic imaging orders into the computerized provider order entry system for meaningful use calculation purposes under the Medicaid Electronic Health Record Incentive Program, and for advancing-care-information purposes under the Merit-Based Incentive Payment System (MIPS).  Without this requirement, the welfare of patients would be jeopardized.

II. The Primary and Alternate Proposals for Calculating the Advancing-Care-Information Performance Category Base Score in the Proposed Rule

The AAMA takes notice of the following excerpts from the Executive Summary of the proposed rule:

(Page 28220, third column)

The primary proposal…of this proposed rule would require a MIPS eligible clinician to report the numerator (of at least one) and denominator…for a subset of measures adopted by the EHR Incentive Programs for EPs [eligible professionals] in the 2015 EHR Incentive Programs Final Rule.  In an effort to streamline and simplify the reporting requirements under the MIPS, and reduce reporting burden on MIPS eligible clinicians, two objectives (Clinical Decision Support and Computerized Provider Order Entry) and their associated measures would not be required for reporting the advancing-care-information performance category.  Given the consistently high performance on these two objectives in the EHR Incentive Programs with EPs accomplishing a median score of over 90 percent for the last 3 years, we believe these objectives and measures are no longer an effective measure of EHR performance and use…

(Page 28221, first column)

The alternate proposal…of this proposed rule would require a MIPS eligible clinician to report the numerator (of at least one) and denominator…for all objectives and measures adopted for Stage 3 in the 2015 EHR Incentive Programs Final Rule to earn the base score portion of the advancing-care-information performance category, which would include reporting a…numerator and denominator for Computerized Provider Order Entry objectives.  We include these objectives in the alternate proposal as MIPS eligible clinicians may feel the continued measurement of these objectives is valuable to the continued use of EHR technology as this would maintain the previously established objectives under the EHR Incentive Programs.

We believe both proposed approaches to the base score are consistent with the statutory requirements and previously established certified EHR technology requirements as we transition to MIPS…

(Page 28227, first and second columns)

Objective: Computerized Provider Order Entry (Alternate Proposal Only)

Objective: Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who can enter orders into the medical record per state, local, and professional guidelines.

III.  The Medicaid EHR Incentive Program continues to require the reporting of all objectives and measures for Stage 3 of the October 16, 2015, Final Rule, as does the alternate proposal in the proposed rule. 

The AAMA takes notice of the following excerpts from the Executive Summary of the proposed rule:

(Page 28233, third column, and page 28234, first column)

We note that the Medicaid EHR Incentive Program for EPs was not impacted by the MACRA [Medicare Access and CHIP Reauthorization Act of 2015] and the requirement under section 1848(q) of the Act to establish the MIPS program.  In this rule, we do not propose any changes to the objectives and measures previously established in rulemaking for the Medicaid EHR Incentive Program, and thus EPs participating in that program must continue to report on the objectives and measures under the guidelines and regulations of that program.

Accordingly, reporting on the measures specified for the advancing-care-information performance category under MIPS cannot be used as a demonstration of meaningful use for the Medicaid EHR Incentive Program.  Similarly, a demonstration of meaningful use in the Medicaid EHR Incentive Program cannot be used for purposes of reporting under MIPS.

Therefore, MIPS eligible clinicians who are also participating in the Medicaid EHR Incentive Program must report their data for the advancing-care-information performance category through the submission methods established for MIPS in order to earn a score for the advancing-care-information performance category under MIPS, and must separately demonstrate meaningful use in their state’s Medicaid EHR Incentive Program in order to earn a Medicaid incentive payment. The Medicaid EHR Incentive Program continues through payment year 2021, with 2016 being the final year an EP can begin receiving incentive payments (§495.310(a)(1)(iii)). We solicit comments on alternative reporting or proxies for EPs who provide services to both Medicaid and Medicare patients and are eligible for both MIPS and the Medicaid EHR Incentive Program.

IV. To reduce duplicative reporting and to simplify the process, the AAMA recommends that all MIPS eligible clinicians (ECs) who continue to participate as eligible professionals (EPs) in the Medicaid EHR Incentive Program be required to report in accordance with the alternate proposal in the proposed rule. 

The AAMA appreciates the opportunity to offer recommendations in regard to the reporting options “for EPs who provide services to both Medicaid and Medicare patients and are eligible for both MIPS and the Medicaid EHR Incentive Program.”

To restate the above-excerpted paragraph beginning on line 102, by enacting the MACRA, Congress did not alter the Medicaid EHR Incentive Program.  Consequently, the measures and objectives for the Medicaid EHR Incentive Program delineated in the aforementioned Final Rule (October 16, 2015) are not affected by the provisions of the proposed rule.  Thus, for example, the following language in the Code of Federal Regulations will continue to be in effect for Medicaid Eligible Professionals (EPs) through payment year 2021:

Section 495.24  Stage 3 meaningful use objectives and measures for EPs, eligible hospitals, and CAHs for 2018 and subsequent years

…

(d) Stage 3 objectives and measures for EPs, eligible hospitals, and CAHs

…

(4) Computerized provide order entry (CPOE)—(i) EP CPOE—(A) Objective.  Use computerized provide order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who can enter orders into the medical record per state, local, and professional guidelines.

…

(1) More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry;

(2) More than 60 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry; and

(3) More than 60 percent of diagnostic imaging orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

Under the proposed rule, Eligible Clinicians (ECs) in the MIPS would be allowed to report in accordance with either the primary proposal or the alternate proposal. If these professionals continue to participate in the Medicaid Incentive Program as Eligible Professionals (EPs), they would have to “separately demonstrate meaningful use in their state’s Medicaid EHR Incentive Program in order to earn a Medicaid incentive payment.” In order to avoid the situation of an EC in the MIPS reporting under the primary proposal, and the same individual as an EP in the Medicaid Incentive Program reporting with a much greater degree of detail in order to comply with meaningful use and receive an incentive payment, the American Association of Medical Assistants recommends to the Centers for Medicare and Medicaid Services that the language of the proposed rule be changed to require MIPS ECs who are also EPs in the Medicaid Incentive Program to utilize the alternate proposal for reporting under the Merit-Based Incentive Payment System.  This revision to the rule would minimize duplicative reporting and confusion for ECs/EPs, and would facilitate auditing by CMS of compliance with both programs.

Thank you for your consideration.  Questions about these comments can be directed to Donald A. Balasa, JD, MBA, AAMA CEO and Legal Counsel, at dbalasa@aama-ntl.org

Medical Assisting Students and CPOE

I have been asked whether medical assisting students doing their practicums/externships are permitted to enter orders into the computerized provider order entry (CPOE) system and have such entry count toward the meaningful use thresholds under the Medicare and Medicaid Incentive Programs.  The following is my response:

During their practicum/externship, students are not permitted to enter medication, laboratory, or diagnostic imaging orders into the CPOE system and have such entry count toward meeting the meaningful use requirements of the Medicare and Medicaid Incentive Programs.  However, it is my legal opinion that externing students—as specifically directed by the overseeing/delegating provider at the practicum site—are permitted to draft orders that a supervising credentialed medical assistant or licensed health care professional reviews.  The credentialed medical assistant or the licensed professional can then enter the orders into the CPOE system and discuss with the externing student any clinical decision support alerts that are generated.  If this approach is followed, the externing student will be able to learn about electronic order entry, and—because the order was entered by a credentialed medical assistant or licensed health care professional—the entry can be included in the meaningful use calculations for the Incentive Programs.

Certifying Board of the AAMA Achieves IAS Accreditation

The AAMA touts the merits of the CMA (AAMA) credential, the highest standard for certification in the medical assisting profession. Those merits have recently been recognized by the International Accreditation Service (IAS), which has granted accreditation for Bodies Operating Certification of Persons to the Certifying Board of the AAMA. The full copy of the press release can be found below.

The Certifying Board of the American Association of Medical Assistants Achieves International Accreditation as a Personnel Certifying Body

CHICAGO—April 20, 2016—The Certifying Board of the American Association of Medical Assistants, Inc. (AAMA) has received independent recognition that its criteria and processes for earning the CMA (AAMA) credential meet ISO/IEC Standard 17024:2012, the global benchmark for personnel certification bodies, distinguishing it from other medical assisting certifications. The Certifying Board of the AAMA has earned accreditation for Bodies Operating Certification of Persons (AC474) from the International Accreditation Service (IAS).

“This recognition demonstrates AAMA’s commitment to ensuring that medical assistants with the CMA (AAMA) credential meet the highest standards,” says Donald A. Balasa, JD, MBA, chief executive officer and legal counsel of the AAMA. “It also further ensures the integrity of the CMA (AAMA) credential for medical assistants, their employers and patients.”

In order to receive accreditation the Certifying Board had to demonstrate that it operates in full compliance with the exacting requirements of ISO/IEC Standard 17024:2012. In so doing, the AAMA has established itself as the most respected and credible personnel certification organization for the medical assisting profession.

A rigorous credential, the CMA (AAMA) is the only certification that requires postsecondary education. Only candidates who graduate from an accredited postsecondary medical assisting program are eligible to sit for the CMA (AAMA) Certification Examination. The CMA (AAMA) must recertify every five years. In addition to ensuring the CMA (AAMA) represents a world class certification, IAS accreditation also validates the credential as an internationally recognized certification, enabling CMAs (AAMA) to obtain similar positions outside of the United States.

Medical assisting is one of the nation’s careers growing much faster than average for all occupations, according to the United States Bureau of Labor Statistics. Medical assistants work in outpatient health care settings and perform both clinical and administrative patient-centered duties. They have knowledge of medical law and regulatory guidelines including HIPAA compliance. Clinical duties vary according to state law and may include taking medical histories, taking and recording vital signs, explaining treatment procedures to patients, preparing patients for examination and assisting the physician during the examination. The administrative duties may include maintaining medical records, including entering the provider’s orders into the electronic health record, managing insurance processes, scheduling appointments, arranging for hospital admission and laboratory services, and billing and coding.

The CMA (AAMA) Certification Program is also accredited by the National Commission for Certifying Agencies (NCCA), a body that reviews and accredits certification programs that meet its Standards for the Accreditation of Certification Programs. The NCCA is an accrediting arm of the Institute for Credentialing Excellence (ICE), formerly called the National Organization for Competency Assurance (NOCA).

For more information about CMA (AAMA) certification or to verify CMA (AAMA) credentials, visit http://www.aama-ntl.org/.

AAMA Submits Comments on Stage 3 Final Rule

In its efforts to stay abreast of state and federal laws pertaining to the medical assisting profession, the AAMA recently submitted comments to the Centers for Medicare and Medicaid Services regarding some specific language from the October 16, 2015 Federal Register. What follows are those comments.

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The following comments are being submitted on behalf of the American Association of Medical Assistants (AAMA), the national organization representing the medical assisting profession at the federal and state levels.

There appears to be an accidental inconsistency between the following language on page 62944 of the final rule, and the following language on pages 62949 and 62950 of the final rule:

Page 62944, third column:

(3) Computerized provider order entry. (i) Objective. Use computerized provider order entry for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

Page 62949, third column, and page 62950, first column:

(4) Computerized provider order entry (CPOE).—(i) EP CPOE—(A) Objective. Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who can enter orders into the medical record per state, local, and professional guidelines. …

(ii) Eligible hospital and CAH CPOE—(A) Objective. Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant; who can enter orders into the medical record per state, local, and professional guidelines.

The American Association of Medical Assistants believes that there is an inconsistency between the above excerpts because of the following language in the analysis of, and responses to, public comments:

Page 62798, second column:

Response: In the Stage 2 final rule (77 FR 53986) and in subsequent guidance in FAQ 9058,6 we explained for Stage 2 that a licensed health care provider or a medical staff person who is a credentialed medical assistant or is credentialed to and performs the duties equivalent to a credentialed medical assistant may enter orders. We maintain our position that medical staff must have at least a certain level of medical training in order to execute the related CDS for a CPOE order entry. We defer to the provider to determine the proper credentialing, training, and duties of the medical staff entering the orders as long as they fit within the guidelines we have proscribed. We believe that interns who have completed their medical training and are working toward appropriate licensure would fit within this definition. We maintain our position that, in general, scribes are not included as medical staff that may enter orders for purposes of the CPOE objective.

However, we note that this policy is not specific to a job title but to the appropriate medical training, knowledge, and experience.

Page 62839, first column:

Response: As noted in the Stage 3 proposed rule (80 FR 16751), we require that the person entering the orders be a licensed health care professional or credentialed medical assistant (or staff member credentialed to the equivalency and performing the duties equivalent to a medical assistant). We defer to the provider’s discretion to determine the appropriateness of the credentialing of staff to ensure that any staff entering orders have the clinical training and knowledge required to enter orders for CPOE.

The American Association of Medical Assistants therefore recommends that the above language on page 62944, third column, be expanded to include “credentialed medical assistants,” as do the above excerpts from page 62949, third column, and page 62950, first column.