Centers for Medicare & Medicaid Services, Computerized Provider Order Entry (CPOE)

New AAMA Initiative Urges Private Payers to Adopt CMS Order Entry Requirements

The Medicaid Promoting Interoperability Program (formerly the Medicaid Electronic Health Record Incentive Program) will be ending December 31, 2021, because of the provisions of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act and the regulations of the Centers for Medicare & Medicaid Services (CMS). One notable requirement of the Medicaid Promoting Interoperability Program for participating licensed providers to receive an annual incentive payment is that they must attest that at least 60% of medication, 60% of laboratory, and 60% of diagnostic imaging orders have been entered into the computerized provider order entry (CPOE) system by either credentialed medical assistants or licensed health care professionals. 

Effective immediately, the Board of Trustees of the American Association of Medical Assistants® (AAMA) has authorized the AAMA to embark upon a nationwide initiative to persuade third-party payers to include the 60% order entry personnel provision in its reimbursement requirements. 

Further information will be forthcoming.

Centers for Medicare & Medicaid Services, education

Medical Assistants’ Competence in Performing Diagnostic Tests: Comments to CMS

On August 14, 2020, I submitted comments to the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services regarding proposed rule CMS-1734-P.

Read those comments in the September/October 2020 Public Affairs article, “Medical Assistants’ Competence in Performing Diagnostic Tests: Comments to the CMS,” on the AAMA website.

Centers for Medicare & Medicaid Services, CMS Rule, Scope of Practice

Testing Period Extension for the AUC Program

Note the recent update via the Centers for Medicare & Medicaid Services on the appropriate use criteria (AUC) program:

NOTICE: The EDUCATIONAL AND OPERATIONS TESTING PERIOD for the AUC Program has been extended through CY 2021. There are no payment consequences associated with the AUC program during CY 2020 and CY 2021. We encourage stakeholders to use this period to learn, test and prepare for the AUC program.

The following describes the intended AUC program timeline, according to the Centers for Medicare & Medicaid Services:

Program Timeline

Currently, the program is set to be fully implemented on January 1, 2022 which means AUC consultations with qualified CDSMs [clinical decision support mechanism] are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid. Prior to this date the program will operate in an Education and Operations Testing Period starting January 1, 2020 during which claims will not be denied for failing to include proper AUC consultation information. Beginning July 1, 2018 the program is operating under a voluntary participation period during which time consultations with AUC may occur and may be reported on furnishing professional and facility claims using HCPCS [Healthcare Common Procedure Coding System] modifier QQ.

As a reminder, I provide supporting evidence for my position that CMAs (AAMA) are clinical staff according to the Centers for Medicare & Medicaid Services rule regarding the AUC program in my Public Affairs article of the September/October 2019 CMA Today. As a result of their clinical staff status, I assert that CMAs (AAMA) are permitted to do the following:

  1. Consult a clinical decision support mechanism (CDSM) about the appropriateness of ordering a particular advanced diagnostic imaging service
  2. Report findings to their overseeing or delegating licensed providers

Find the article, as well as all my other Public Affairs articles, on the AAMA website.

Centers for Medicare & Medicaid Services, CMS Rule, delegation, Scope of Practice

CMS Final Rule Supports Medical Assistants Performing Nasopharyngeal Swabbing

The Centers for Medicare & Medicaid Services (CMS) published an interim final rule with comment period entitled “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” (85 FR 19247 through 19253) in the April 6, 2020, Federal Register. Its language supports my legal position that medical assistants are permitted to perform nasopharyngeal swabbing to test for COVID-19.

Note the following excerpts from this CMS rule:

Even if the patient is confined to the home because of a suspected diagnosis of an infectious disease as part of a pandemic event … a nasal or throat culture … could be obtained by an appropriately-trained [sic] medical assistant or laboratory technician. …

… Services furnished by auxiliary personnel (such as nurses, medical assistants, or other clinical personnel acting under the supervision of the [rural health clinic] or [federally qualified health center] practitioner) are considered to be incident to the visit and are included in the per-visit payment.

Centers for Medicare & Medicaid Services, On the Job, Scope of Practice

Medical Assistants’ Role in RPM Services

Medical assistants meet the criteria for clinical staff for several well-known programs (the Medicare Chronic Care Management (CCM) and Transitional Care Management (TCM) programs and the Medicare appropriate use criteria program for advanced diagnostic imaging services). But what is medical assistants’ scope of practice for other services, such as remote physiologic monitoring (RPM) services?

To answer this question, review relevant information from the Centers for Medicare & Medicaid Services (CMS) on Current Procedural Terminology (CPT) code structure and several general legal principles presented in the March/April 2020 Public Affairs article, “Medical Assistants’ Role in Remote Physiologic Monitoring Services,” on the AAMA website.