Scope of Practice in Correctional Facilities

The versatility of CMAs (AAMA) is being reflected in the questions I am starting to receive about the scope of practice for medical assistants working in correctional facilities.

If the CMAs (AAMA) are working under direct provider supervision in a clinic within a correctional facility, the standard laws for medical assisting scope of practice apply.  However, if a CMA (AAMA) is functioning as a medication aide and distributing medications under registered nurse supervision (similar to what occurs in a skilled nursing facility or an assisted living facility), the medical assistant would have to meet the state requirements and register with the appropriate state agency as a medication aide.

CMA Today Referenced in Part B News

As many readers of this blog know, I write at length about legal issues affecting the medical assisting profession in each issue of CMA Today, the official publication of the American Association of Medical Assistants. Recently, one of those articles was referenced in a question-and-answer piece in Part B News. (Note: Subscription required.)

The write-up discusses CPT code 69209 (Removal of cerumen using irrigation/lavage) and whether the procedure can be billed if a medical assistant performs it. The author notes several important considerations—for example, the differences in state law and the vagaries of some CPT language—in addition to discussing the CPT definition of “clinical staff” as it relates to medical assistants. Ultimately, the author states the following:

In aggregate, when it comes to medical assistants being eligible to perform services incident to a physician, the answer is “generally yes,” according to recent guidance from the American Association of Medical Assistants (AAMA).

The language the author cited was from my article “‘Incident-to’ billing: Medical assistants’ services under the Medicare CCM program,” which can be found on the AAMA website.

Eligible Professionals in the Medicaid EHR Incentive Program

I would like to note the recent update on eligible professionals (EPs) from the Centers for Medicare & Medicaid Services:

EPs that attest directly to a state for that state’s Medicaid EHR Incentive Program will continue to attest to the measures and objectives finalized in the 2015 EHR Incentive Programs Final Rule (80 FR 62762 through 62955). In 2017, Medicaid EPs have the option to report to the Modified Stage 2 or Stage 3 objectives and measures.

As a reminder, the following are considered to be EPs under the Medicaid Incentive Program:

• Doctors of medicine
• Doctors of osteopathy
• Doctors of dental medicine or surgery
• Nurse practitioners
• Certified nurse midwives
• Physician assistants (PAs) when working at a federally qualified health center or rural health clinic that is so led by a PA

Finally, please note the following language from the 2015 final rule, which is referred to in the previous block quote and is attached at the end of this post:

We are adopting the objective for EPs, eligible hospitals and CAHs [critical access hospitals] as follows:

Objective 4: Computerized Provider Order Entry

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.

Measure 1: More than 60 percent of medication orders created by the EP or authorized providers of the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry;

• Denominator: Number of medication orders created by the EP or authorized providers in the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
• Numerator: The number of orders in the denominator recorded using CPOE.
• Threshold: The resulting percentage must be more than 60 percent in order for an EP, eligible hospital, or CAH to meet this measure.
• Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period.

Measure 2: More than 60 percent of laboratory orders created by the EP or authorized providers of the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry; and

• Denominator: Number of laboratory orders created by the EP or authorized providers in the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
• Numerator: The number of orders in the denominator recorded using CPOE.
• Threshold: The resulting percentage must be more than 60 percent in order for an EP, eligible hospital, or CAH to meet this measure.
• Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.

Measure 3: More than 60 percent of diagnostic imaging orders created by the EP or authorized providers of the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry.

• Denominator: Number of diagnostic imaging orders created by the EP or authorized providers in the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
• Numerator: The number of orders in the denominator recorded using CPOE.
• Threshold: The resulting percentage must be more than 60 percent in order for an EP, eligible hospital, or CAH to meet this measure.
• Exclusion: Any EP who writes fewer than 100 diagnostic imaging orders during the EHR reporting period.

Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 Through 2017; Final Rule

Can Medical Assistants Oversee and Perform Physical Therapy?

Recently I fielded a question from a chiropractor in New Jersey looking to expand his practice to include services such as physical therapy. In conducting research into this matter, he had been told that in New Jersey, state law allows MDs to delegate to medical assistants full oversight and performance of physical therapy activities, as prescribed by the MD. He asked whether this was true.

In my response, I cited a recent CMA Today article that addresses this very topic:

An example of [procedures that can be delegated only to certain health professionals other than medical assistants] is physical therapy. Although some states—explicitly or implicitly—permit physicians to delegate very minor physical therapy modalities to competent and knowledgeable medical assistants working under the physician’s direct supervision, no state allows a physician to delegate the full range of physical therapy to anyone other than a licensed physical therapist.

In addition, I recommended contacting the New Jersey Board of Chiropractic Medicine to inquire whether New Jersey statutes, regulations, and policies permit doctors of chiropractic medicine to assign to unlicensed professionals such as medical assistants the overseeing of patients performing exercises assigned by an MD, and whether there are any legal limitations on this. (Similarly, I would recommend such action to chiropractors in other states, as well.)

Medical Assistants in Dental Offices

This blog frequently discusses scope-of-practice issues, but health care always provides new questions to examine. This post will address the following: Are medical assistants permitted to work in a dental office under the authority/supervision of a dentist?

First of all, it is important to keep in mind the distinction between a dental hygienist and a dental assistant. Under the laws of all American jurisdictions, dental hygienists are required to be licensed. Licensure for dental hygienists requires graduation from a postsecondary dental hygiene academic program and the passing of a national (and in some cases, state) examination. Thus, medical assistants—including CMAs (AAMA)—are not permitted to work as dental hygienists.

Under the laws of some states, dental assistants are required to have formal education and pass a test in order to be delegated certain tasks by the overseeing/delegating dentist. Other states have no educational or testing requirements for dental assistants. A medical assistant should check with the state board of dental examiners (usually in the state capital) to find out whether the state has any educational or testing requirements for dental assistants, and whether any of the medical assisting education or credentialing can be used toward meeting any state requirements for dental assistants.