Can Washington State Medical Assistants Use the “CMA” Initialism?

With a variety of certifications associated with the medical assisting profession, confusion runs rampant regarding who is permitted to write “CMA” after their name, thereby using the CMA^CM initialism. For instance, I received the following question:

I have been a CMA (AAMA) for many years and recently moved to Washington state. Washington law requires a medical assistant to register with the Washington Department of Health as a medical assistant-certified (MA-C) or a medical assistant-registered (MA-R) to be delegated certain clinical tasks. My question is this: Is an MA-C allowed to use the CMA initialism?

As you have stated, the MA-C and the MA-R are medical assisting credentials established by the Washington legislature and administered by the Washington Department of Health. They do not have a “legal existence” outside of the provisions of Washington law. The CMA (AAMA)® is a national medical assisting credential. The CMA (AAMA) Certification Program and the Certifying Board of the AAMA are accredited by the National Commission for Certifying Agencies, the National Certification Commission, and under International Standard ISO:IEC 17024, Conformity Assessment—General Requirements for Bodies Operating Certification of Persons. The CMA (AAMA) has a national and international existence as a medical assisting credential.

Only medical assistants who have passed the CMA (AAMA) Certification Exam have been awarded the CMA (AAMA) credential by the Certifying Board of the AAMA and who have kept their CMA (AAMA) current by continuing education or testing are permitted to use the CMA (AAMA) designation. Not all Washington MA-Cs have a current CMA (AAMA). Only those MA-Cs who have a current CMA (AAMA) are permitted to use the CMA (AAMA) or CMA^CM initialisms after their names.

Medical Assistants and Fetal Nonstress Test Monitors

State laws are the best place to look for guidance on medical assisting scope of practice, but they are sometimes less thorough than desired. For cases such as those, consider the following:

We have some CMAs (AAMA) and RMAs(AMT) assisting physicians who are providing obstetrical services. The physicians delegate to the medical assistants the hooking up of patients to fetal nonstress test monitors. The medical assistants do not interpret the results of the fetal nonstress test. Is this delegation permitted by Minnesota law?

Based on my research, hooking up a patient to a fetal nonstress test monitor is a straightforward, repeatable process that does not require (1) the knowledge or skill or a licensed health care professional, (2) the exercise of independent clinical judgment, or (3) the making of clinical assessments. Therefore, my legal opinion is that this task is likely delegable to knowledgeable and competent unlicensed allied health professionals such as medical assistants working under direct/onsite physician supervision.

The delegating physicians should reverify periodically (perhaps every 12 months) the knowledge and skill of the medical assistants performing this task and should document in writing each medical assistant’s current competence in this task.

It may also be advisable to request a written opinion from the practice’s malpractice insurance carrier stating that it would cover any negligence by a medical assistant in hooking up a patient to a fetal nonstress test monitor.

The Role of Medical Assistants in Increasing Colorectal Cancer Screening Rates

On April 16, 2019, I presented a webinar for the Illinois Primary Health Care Association to illustrate that the utilization of knowledgeable and competent medical assistants, especially CMAs (AAMA), across health care settings significantly increases colorectal cancer (CRC) screening rates.

Review the supporting evidence in the July/August 2019 Public Affairs article, “The Role of Medical Assistants in Increasing Colorectal Cancer Screening Rates,” on the AAMA website.

Relaying Providers’ Orders by Telephone

Part of the AAMA’s mission is to protect medical assistants’ scope of practice. Sometimes that means gathering evidence to prove that what other health professionals think is a limitation of medical assistants’ scope of practice is unsubstantiated by state law. Consider the following from a medical assistant in Wisconsin:

I work in a small physician-owned clinic. Our primary care providers visit two local skilled nursing facilities each month. … [Does] our state permit nurses to take a provider’s order by telephone that is conveyed by a medical assistant? These telephone orders are always followed up by a written electronic order from the provider. [But] we are being told that nursing home staff will only take telephone orders directly from licensed health professionals.

Why would this be any different from a provider directing one of our medical assistants to convey a normal lab value? Our providers would spend all day calling the nursing homes if medical assistants cannot relay information at the request of the provider. If the nursing home staff members do not understand the order, they can always ask for clarification from one of our providers.

I reviewed the nurse practice act and the regulations and policies of Wisconsin’s state board of nursing. I found nothing stating that registered nurses (RNs) and licensed practical nurses (LPNs) are prohibited from receiving and executing orders from a licensed provider (e.g., physicians, nurse practitioners, physician assistants) that are transmitted verbatim by telephone by an unlicensed allied health professional, such as a medical assistant.

Unless state law specifically indicates otherwise, my legal opinion is that knowledgeable and competent medical assistants are permitted to convey verbatim information (including orders) on behalf of the delegating provider and receive verbatim information for the overseeing provider. Information conveyed by telephone should be followed up by a written order (electronic or hard copy).

Standing Orders and Supervision Requirements

I welcome further questions about my blog posts because addressing those questions allows me to dive deeper into a pertinent topic for medical assistants who wish to better understand their scope of practice.

For instance, in response to my blog post “Standing Orders from an Overseeing Provider,” I received the following question:

Does a standing order change the supervision requirements for medical assistants? For example, if our state law requires the delegating licensed provider to be on the premises when a medical assistant is performing venipuncture, is this supervision requirement changed by a standing order from the provider?

A standing order does not change the supervision requirement established by state law. The supervision requirements apply regardless of whether the licensed provider issues a standing order, verbal order, or written order. If this were not the case, a provider could circumvent supervision requirements by issuing standing orders instead of verbal orders.

The purpose of supervision requirements is patient protection.