Who Is Eligible for an NPI?

Determining who’s eligible for a National Provider Identifier (NPI) number may require some research, which is why, in part, I recently received the following request:

Mr. Balasa, I read with interest the following from your recent post to Legal Eye, “Medical Assistants and Incident-to Billing”:

Medical assistants do not have National Provider Identifier (NPI) numbers because they are not reimbursed directly by Medicare for their services. Rather, their services may only be billed and reimbursed incident to the services of the delegating provider.

Could you please provide documentation of which health professionals are and are not eligible for an NPI number?

Medical assistants whose employers request them to get an NPI number may use the following documentation to educate and provide clarity to employers and coworkers.

Note the following from a Centers for Medicare & Medicaid Services (CMS) fact sheet:

• Who? All individuals and Organizations who meet the definition of health care provider as described at CFR 160.103 are eligible to obtain a National Provider Identifier, or NPI.

Note the following definition from 45 CFR 160.103:

Health care provider means a provider of services (as defined in section 1861(u) of the Act, 42 U.S.C. 1395x(u)), a provider of medical or health services (as defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business.

Section 1861(s) of the Social Security Act does not contain a reference to medical assisting services. It references explicitly the services of the following health professionals:

• Physicians
• Nurse practitioners
• Physician assistants
• Certified nurse-midwives
• Qualified psychologists
• Clinical social workers
• Certified registered nurse anesthetists

Therefore, according to federal statute and CMS rule, medical assistants are not considered health professionals who are eligible for NPI numbers.

Medical Assistants and Incident-to Billing

What is meant by the statement that the services of a medical assistant must be billed “incident to” the services of the delegating physician for the physician to be reimbursed for the medical assistant’s services under Medicare?

Legally, medical assistants work under direct/onsite provider (e.g., physician, nurse practitioner, physician assistant) supervision and authority in outpatient settings. Medical assistants do not have National Provider Identifier (NPI) numbers because they are not reimbursed directly by Medicare for their services. Rather, their services may only be billed and reimbursed incident to the services of the delegating provider.

Note the following from the Medicare Benefit Policy Manual:

Incident to a physician’s professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness. …

Auxiliary personnel means any individual who is acting under the supervision of a physician, regardless of whether the individual is an employee, leased employee, or independent contractor of the physician, or of the legal entity that employs or contracts with the physician. …

Thus, where a physician supervises auxiliary personnel to assist him/her in rendering services to patients and includes the charges for their services in his/her own bills, the services of such personnel are considered incident to the physician’s service if there is a physician’s service rendered to which the services of such personnel are an incidental part.

For more information, see my Public Affairs article from the March/April 2018 CMA Today: “Medicare CCM and TCM Programs: Defining Medical Assistants’ Roles and Services.”

Performing Unfamiliar Tasks

If you have ever been asked to perform a task unfamiliar to you, consider the following situation brought to my attention:

My physician-employer asked me to perform a task that I have never done and did not learn in my medical assisting program. I explained to my employer that I did not feel it was right for me to perform the task because I didn’t have any experience with it and did not feel competent doing the task. My physician-employer said that I should perform the task to the best of my ability and not worry because she would be legally liable if something went wrong and I would not be. Is this correct? Should I perform the task?

It is my legal opinion that medical assistants should not perform a task for which they are not knowledgeable and competent. This is one of the most important legal and ethical duties of medical assistants.

It is true that the delegating provider is responsible for any negligence of a medical assistant in performing a task delegated by the provider to the medical assistant. However, it is not correct that the medical assistant is not responsible legally for performing a task in a negligent manner.

The correct legal principle is that the delegating provider and the medical assistant are responsible under civil law for any negligence by a medical assistant. A medical assistant is under the legal duty of performing all tasks to a level of quality that is equal to or greater than the level of quality that a reasonably knowledgeable and competent medical assistant would exhibit in performing the task.

“Medical Office Assistant” vs. “Medical Assistant”

Inconsistency in the usage of similar-sounding terms related to medical assisting is bound to cause confusion. The following question demonstrates one such instance:

Is there a difference between a medical assistant and a medical office assistant? Health systems in our region seem to use these terms to describe the same category of allied health professional.

Medical office assistant and medical assistant were used interchangeably to describe allied health professionals who are knowledgeable and competent in both clinical and administrative tasks and responsibilities in outpatient delivery settings. This meaning of medical office assistant has become less frequent in recent years, and the vast majority of federal and state statutes and regulations employ the phrase medical assistant.

In certain contexts, medical office assistant describes an individual who performs only administrative tasks in an ambulatory-care setting. Even this usage has become less frequent. Individuals who perform only administrative tasks in an outpatient environment are now more commonly referred to as administrative medical assistants or administrative assistants.

Schools continue to offer educational programs that address only the administrative aspects of medical assisting. Keep in mind that graduates of these programs are not eligible for the CMA (AAMA) Certification Examination. Only graduates of medical assisting programs accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) that teach both clinical and administrative knowledge, skills, and professional attributes and behaviors—and thus meet the CAAHEP- and ABHES-accreditation standards for medical assisting programs—are eligible for the CMA (AAMA) Certification Examination.

Comments to the Montana Board of Medical Examiners

In the effort to protect patients in Montana from substandard medical assisting services, the Montana Society of Medical Assistants (MSMA) and the American Association of Medical Assistants (AAMA) wrote to the Montana Board of Medical Examiners on the proposed New Rule I “Medical Assistant—Delegation and Supervision.” Read the comments as well as an excerpt from the proposed new rules in the latest Public Affairs article. Access “Comments to the Montana Board of Medical Examiners” in the September/October 2018 issue of CMA Today on the AAMA website.