The Misuse of Medical Assisting Credentials May Have Legal Consequences

The roles of medical assistants have expanded and diversified during the last 10 years. So too have the number and types of medical assisting credentials. In this blog post, I will explain basic facts about medical assisting credentials and the potential legal consequences of misusing them.

Licensing and Certification

A license is a mandatory credential, usually issued by a state, without which an individual is not permitted by law to practice a profession. A certification is most frequently a voluntary credential, usually issued by a private-sector body, that provides evidence of an individual’s knowledge and competence in a profession. A license is required by law; a certification is (with limited exceptions) not required by law.

Examples of medical assisting licenses are the “medical assistant-certified (MA-C)” and the “medical assistant-registered (MA-R)” issued by the Washington State Department of Health.

Accreditation of Certification Programs

There are two accreditations available to U.S. certification programs:

• Accreditation by the National Commission for Certifying Agencies (NCCA) under its Standards for the Accreditation of Certification Programs
• Accreditation under International Standard ISO/IEC 17024:2012, Conformity Assessment—General Requirements for Bodies Operating Certification of Persons (ISO 17024)

Accreditation of the CMA (AAMA) Certification Program

The CMA (AAMA)® is a medical assisting certification issued by the Certifying Board of the American Association of Medical Assistants® (AAMA). The CMA (AAMA) certification program is the only medical assisting certification program that is accredited both by the NCCA and under ISO 17024.

Permissible Use of the CMA (AAMA) Credential

The only medical assistants permitted to use the CMA (AAMA) designation in connection with employment or seeking employment are those medical assistants who have achieved certification through the Certifying Board of the American Association of Medical Assistants (AAMA) and whose CMA (AAMA) credential is current. A medical assistant who never held the CMA (AAMA) or who formerly held the CMA (AAMA) but whose CMA (AAMA) is not current is forbidden from using the CMA (AAMA) credential. A medical assistant who violates this policy is in jeopardy of sanctions by the Certifying Board of the AAMA and sanctions under federal trademark law.

Registration of the CMA (AAMA)

The AAMA registered the “CMA (AAMA)” designation/initialism with the United States Patent and Trademark Office (USPTO) as a certification mark. This registration gives the AAMA intellectual property rights in this designation. A certification mark “is a type of trademark that is used to show consumers that particular goods and/or services, or their providers, have met certain standards,” according to the USPTO.

Registration of the “Certified Medical Assistant” Phrase

The three-word phrase “certified medical assistant” has also been registered by the AAMA with the USPTO. Consequently, this three-word phrase should not be used as a generic reference to all medical assistants. This phrase should also not be used as a generic reference to all medical assistants who hold a credential. “Certified medical assistant” should only be used when referring to medical assistants who hold a current CMA (AAMA).

The Legal Status of the “CMA” Initialism

The “CMA” initialism is not registered with the USPTO. This is because the official designation of the credential awarded by the Certifying Board of the AAMA was changed from “CMA” to “CMA (AAMA),” effective January 1, 2008. However, the AAMA retains common law rights in the initialism “CMA.” For example, if the initialism “CMA” were used in a way that would likely confuse employers or other parties into thinking that the reference to “CMA” was a reference to “CMA (AAMA),” the AAMA would likely have a cause of action against the misusing party.

State Law Authorizing the Use of “CMA” as an Abbreviation of “Certified Medication Aide/Assistant”

Statutes or regulations of some states permit or require the initialism “CMA” to be used as the designation for “certified medication aides” or “certified medication assistants.” Such state laws do not infringe the AAMA’s common law rights in the “CMA” initialism because the authority of a government to define an initialism and restrict its use supersedes the authority of a private-sector body—such as a certifying board—to do so. In fact, in some states it is a violation of state law to use “CMAs” to refer to medical assistants rather than medication aides. This is another example of negative legal consequences resulting from the misuse of a credential.

State Law Requiring Words or Initials to Be Used on Medical Assistants’ Name Tags

Some states’ laws require words or initialisms to be on the name tags of medical assistants. These laws must be obeyed. If they are not, legal sanctions may result.

The Display of Medical Assisting Credentials in EHR Platforms

Employers will sometimes tell medical assistants that the electronic health record (EHR) platform of the clinic, practice, or health system will not permit the inclusion of medical assistants’ credentials. This is usually not the case. Most EHR platforms have this capability.

Questions should be directed to me in the comments or via email at DBalasa@aama-ntl.org.

Who Can Take the CMA (AAMA)® Exam?

Q. Who is eligible to take the CMA (AAMA)® Certification Exam?

A. The only individuals eligible to take the CMA (AAMA) Certification Exam and become CMAs (AAMA) are graduates or graduating students of medical assisting programs that fall within one of the following categories:

• Accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP)
• Accredited by the Accrediting Bureau of Health Education Schools (ABHES)
• Meets the criteria for the time-limited Certification Exam Eligibility Pilot Program

The Certification Exam Eligibility Pilot Program is a three-year pilot program, begun August 2019, that allows graduates of postsecondary (college-level) medical assisting programs to take the CMA (AAMA) Exam if the program meets certain requirements, including the program being part of an institution accredited by an accrediting body recognized by either the United States Department of Education (USDE) or the Council for Higher Education Accreditation (CHEA).

Hopeful exam candidates can gather all required documentation and submit their documentation for review—to see if they are eligible under the pilot program—for free online via the AAMA website.

The CMA (AAMA)® Certification Exam Eligibility Pilot Program

The Certifying Board (CB) of the American Association of Medical Assistants® (AAMA) has approved the launch of a three-year eligibility pilot program, which temporarily opens a new education pathway for medical assistants to become eligible to sit for the CMA (AAMA)® Certification Exam.

Applicants first submit their documentation for review, free of charge, to determine their eligibility to apply for the exam. The criteria and submission requirements for the review are outlined on the Eligibility Pilot Program webpage of the AAMA website.

Before implementing the program, the CB took into account several policy priorities, including but not limited to the following:

• Maintaining global and national accreditation standards
• Heeding a recommendation from the National Commission for Certifying Agencies
• Needing to collect and evaluate empirical evidence on examination performance by candidates who are not graduates of accredited medical assisting programs

Examine all the CB’s considerations and rationale in detail by reading the November/December 2019 Public Affairs article, “The CMA (AAMA)® Certification Exam Eligibility Pilot Program: Criteria and Rationale for the Three-Year Pilot Study,” on the AAMA website.

“Certified Medical Assistant” vs. “Medical Assistant-Certified” in Washington: A Review of Permissible Usage among Programs

The distinction between “certified medical assistant” and its variations can be difficult for medical assisting programs to make. Trademark registrations and state law need to be taken into consideration.

Take this question for example:

Can a Washington-based medical assisting program that meets the requirements of the Washington State Department of Health (e.g., graduates can become a “medical assistant-certified” [MA-C]) but not the CMA (AAMA)® Certification Exam use the phrase “certified medical assistant” in connection with their program?

The American Association of Medical Assistants® (AAMA) holds a trademark registration with the U.S. Patent and Trademark Office for the phrase “certified medical assistant.” Any party’s use of the phrase that is likely to confuse or mislead the public is an infringement of the AAMA’s intellectual property rights in the phrase.

Medical assisting programs that are not accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) should not use the phrase because it could be misconstrued as their graduates being eligible for the CMA (AAMA) Certification Exam.

Washington State Legislature has established several categories for medical assistants (WAC 246-827-0010), but the medical assistant-certified (MA-C) category is the one most likely to be confused with “certified medical assistant” permissible usage. Note the requirements for becoming an MA-C:

WAC 246-827-0200

Medical assistant-certified—Training and examination.

An applicant for a medical assistant-certified credential must meet the following requirements:

(1) Successful completion of one of the following medical assistant training programs:

(a) Postsecondary school or college program accredited by the Accrediting Bureau of Health Education Schools (ABHES) or the Commission of [sic] Accreditation of Allied Health Education Programs (CAAHEP);

(b) Postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education, which includes a minimum of seven hundred twenty clock hours of training in medical assisting skills, including a clinical externship of no less than one hundred sixty hours;

(c) A registered apprenticeship program administered by a department of the state of Washington unless the secretary determines that the apprenticeship program training or experience is not substantially equivalent to the standards of this state. The apprenticeship program shall ensure a participant who successfully completes the program is eligible to take one or more examinations identified in subsection (2) of this section; or

(d) The secretary may approve an applicant who submits documentation that he or she completed postsecondary education with a minimum of seven hundred twenty clock hours of training in medical assisting skills. The documentation must include proof of training in all of the duties identified in RCW [Revised Code of Washington] 18.360.050(1) and a clinical externship of no less than one hundred sixty hours.

(2) Pass a medical assistant certification examination, approved by the secretary, within five years of submitting an initial application. A medical assistant certification examination approved by the secretary means an examination that:

(a) Is offered by a medical assistant program that is accredited by the National Commission for Certifying Agencies (NCCA); and

(b) Covers the clinical and administrative duties under RCW 18.360.050(1).

Consequently, if the medical assisting program meets (1)(a), (b), (c), or (d), it would be permissible for the program to state that graduates meet the educational portion of the MA-C requirements. It would also be permissible to state that graduates would be eligible for one or more of the NCCA-accredited medical assisting certification programs.

For more information on whether a Washington-based MA-C can write “CMA” after their name, see my blog post “Can Washington State Medical Assistants Use the ‘CMA’ Initialism?”

Medical Assisting Programs Should Maintain Programmatic Accreditation

Since the announcement of the CMA (AAMA)® Certification Exam Eligibility Pilot Program, many people have had questions concerning its rationale and ramifications. Take the following set of questions for example:

This new pilot program has North Carolina educators in deep discussion. I wanted to clarify a few items before presenting this new pilot program to my advisory board:

1. What is the benefit of programs to maintain accreditation if students can sit for the CMA (AAMA) Certification Exam in a nonaccredited program?
2. When students find out about this pilot program, retention rates could be affected. Is the AAMA prepared to address this issue? I can imagine that curriculum revisions will be increasing. Our college administration has insisted that we offer a one-year diploma that is not accredited to offer students the opportunity to complete faster. 
3. Is the pilot program expected to be available for three years?

Those are great questions. Medical assisting programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) should maintain their programmatic accreditation because state boards of medical examiners and state boards of nursing have established education and/or credentialing requirements for medical assistants who are delegated the administration of medication by physicians, physician assistants, and advanced practice registered nurses (APRNs), especially nurse practitioners.

Note the following requirements for medical assistants to be registered, and therefore permitted to work as medical assistants, from the joint rules of the South Dakota Board of Nursing and the South Dakota Board of Medical and Osteopathic Examiners:

20:84:04:01. Approved education programs. An applicant for registration shall have graduated from a medical assistant program that is approved by the boards or accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), or a similar accrediting institution approved by the United States Department of Education. Approved programs must provide classroom, laboratory, and clinical learning experiences that provide for student attainment of entry-level competence as a registered medical assistant.

The number of CAAHEP- and ABHES-accredited medical assisting programs—and the number of their graduates—has decreased in the last five years. Some programs have closed, and some continue to offer a medical assisting program but have discontinued their programmatic accreditation.

However, anecdotal evidence is emerging that accredited medical assisting programs that have articulation agreements with other allied health programs are experiencing stable if not increasing enrollment in their medical assisting programs.

And yes, the CMA (AAMA) Certification Exam Eligibility Pilot Program will be available for three years, which began in August 2019. For more information, visit the Eligibility Pilot Program webpage on the AAMA website.