The Role of Medical Assistants in the Medicare Annual Wellness Visit

The role of medical assistants—especially CMAs (AAMA)—in the Medicare Annual Wellness Visit (AWV) continues to be a topic of interest and inquiry for health care professionals. The latest Public Affairs article attempts to clarify what AWV tasks are and are not delegable to medical assistants. Read “The Role of Medical Assistants in the Medicare Annual Wellness Visit” in the July/August 2018 issue of CMA Today on the AAMA website.

Can LPNs Take the CMA (AAMA) Exam?

I field many questions from health professionals with a variety of educational and professional backgrounds about the eligibility requirements for the CMA (AAMA) Certification Examination. Many wonder, If I have this knowledge and experience, am I eligible to take the CMA (AAMA) Exam? If you are one such person, consider this question and response:

I am a licensed practical nurse (LPN). Would it be possible for me to take the CMA (AAMA) Certification Examination? Some employers in my area prefer to hire CMAs (AAMA) rather than LPNs.

This is my response:

Only graduates of CAAHEP- or ABHES-accredited medical assisting programs are eligible for the CMA (AAMA) Certification Examination. I suggest that you contact CAAHEP- and ABHES-accredited medical assisting programs in your areas and see whether they would accept some of the courses you took in your LPN program in lieu of similar courses in the medical assisting program.

Medical Assistants and the Medicare Annual Wellness Visit

There seems to be some confusion about what a medical assistant is permitted to do in connection with a Medicare Annual Wellness Visit (AWV). Let’s start with a description of a Medicare AWV from the May/June 2015 CMA Today article “Prioritizing Prevention: Medicare’s Annual Wellness Visit”:

The yearly wellness visit provides seniors with a general health-risk assessment that includes screenings for depression, cognitive impairment, and other health concerns. At the visit, health care providers review the patient’s medical and family history, docu­ment vital measurements, such as height, weight, and blood pressure, and update lists of current providers and prescriptions. At the conclusion of the visit, the patient is provided with a personal health plan, including a long-term schedule for future screenings and preventive services.

Note the following document from the Centers for Medicare & Medicaid Services (CMS), “The ABCs of the Annual Wellness Visit”:

Medicare Part B covers an AWV if performed by a:

• Physician (a doctor of medicine or osteopathy)
• Qualified non-physician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist)
• Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals who are directly supervised by a physician (doctor of medicine or osteopathy)

It is my legal opinion that federal law permits medical assistants to assist licensed health care providers (e.g., MDs/DOs, nurse practitioners, physician assistants) in the performing of an AWV. However, medical assistants are not permitted to perform any part of the AWV that requires the medical assistant to make independent clinical judgments or to make clinical assessments or evaluations.

Can CMAs (AAMA) Be Ophthalmic Technicians, and Vice Versa?

Often the questions I receive from CMAs (AAMA) are as versatile as the health professionals asking them. Although some questions focus on an individual’s specific circumstance, they present a situation all CMAs (AAMA) with certification questions can learn something from. The following question is one such case:

I would like to know if a CMA (AAMA) is permitted to work at the office of an ophthalmologist as an ophthalmic technician and be able to continue to hold and recertify the CMA (AAMA) credential.

The answer to your question is yes. One of the many advantages of the CMA (AAMA) is the variety of professional opportunities that are available. CMAs (AAMA) work in the offices of ophthalmologists in various capacities.

The Certifying Board of the AAMA places no restrictions on the types of positions CMAs (AAMA) must hold in order to be eligible to recertify. You are permitted to work as an ophthalmic technician and recertify your CMA (AAMA) by continuing education or retesting.

Duties and Delegation Abroad

I field many scope-of-practice questions in my work, some of which are highly specific to the individuals posing them. Others can be applied more broadly, however. These serve as interesting material to share with readers of this blog. The following is one such question I received recently.

I practice as a medical assistant in North Carolina. I routinely travel outside the country for medical missions. As a CMA (AAMA), when working under a physician licensed in another country, am I permitted to perform the same tasks that I am allowed to perform under North Carolina law?

I responded as follows:

Thank you for your most interesting question.  Your legal scope of practice would depend on the laws of the country in which you are working.  You would not necessarily be able to perform the same tasks you are delegated in North Carolina.

However, to take your question a step further, it is my legal opinion that—if a physician licensed in North Carolina also went on such a mission trip—the physician would be permitted to delegate to you the same tasks that he/she delegates to you under North Carolina law.  This same legal principle would apply to nurse practitioners and physician assistants licensed in North Carolina.

Note that the state in question here is largely interchangeable. Were the medical assistant and physician from Oklahoma, for example, the same legal principle would apply, only specific to Oklahoma law instead of North Carolina.