Medicare, On the Job, Professional Identity

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.”

On the Job, Scope of Practice

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.

Certification and the CMA (AAMA) Credential, On the Job, Professional Identity

“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.

delegation, On the Job, Scope of Practice

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.

Certification and the CMA (AAMA) Credential, medication assistant, On the Job, Professional Identity

Levels of Medical Assisting

Here is an interesting question about “levels” of medical assisting:

I work for a very large cardiology practice in North Carolina. Is it permissible to establish tiers of medical assistants based on their skill sets? For example, are we permitted under North Carolina law to have categories such as Medical Assistant I, Medical Assistant II, Medical Assistant III based on the medical assistant’s education, credentialing, and skill sets?

North Carolina law does not forbid employers from establishing tiers or levels of medical assistants. An employer is allowed to determine what elements of knowledge and skill are required for each category of medical assistants and what tasks should be assigned to medical assistants in the respective categories.

However, these levels should not have “CMA” in their titles. The American Association of Medical Assistants (AAMA) has intellectual property rights to the phrase “certified medical assistant” and the initialisms “CMA (AAMA)” and “CMA.”

Titling these classifications as Medical Assistant I, II, III is permitted under North Carolina law and does not infringe on the trademark and intellectual property rights of the AAMA. See the State Scope of Practice Laws webpage on the AAMA website to access key state legislative materials pertaining to medical assisting.