On the Job

Medical Assistant Eligibility for Transitioning to Other Positions 

I recently received the following question: 

I would like to know why a CCMA [certified clinical medical assistant] in Texas can’t test out of the CCMA program and test to be a certified medication aide without having to become a certified nursing assistant first? 

Answers to this question can be found in my July/August 2012 Public Affairs article, “Legal Difference Between Working in Inpatient and Outpatient Settings.” 

Concisely, in Texas and most other states, medical assistants are governed by the medical practice act and the regulations and policies of the state medical board. Medication aides are governed by different laws, such as the public health act or nurse practice act. Medication aides also function under a board of health or board of nursing.

Also, medical assisting education is different from the education of nursing assistants and medication aides.

For these reasons, credentialed medical assistants are not automatically eligible to become certified nursing assistants or certified medication aides. 

On the Job, Scope of Practice

Permissible Tuberculin Skin Test Tasks for Pennsylvania Medical Assistants 

I recently received the following question: 

I am a CMA (AAMA) working in Pennsylvania. What does Pennsylvania law allow medical assistants to do in regard to tuberculin skin tests? 

To answer this question, note the following from the Pennsylvania Department of Human Services Bureau of Human Services Licensing

Question: Are medical assistants permitted to read an individual’s TB [tuberculosis] skin test? 

Answer: According to the Centers for Disease Control and Prevention (CDC), a TB skin test should be read by a “health-care worker trained to read tuberculin skin testing (TST) results.” Therefore, a medical assistant who has been trained to read TST results is considered qualified and is permitted to do so under the regulations. 

The laws of other states vary greatly concerning what medical assistants are permitted to do in regard to tuberculin skin tests. Please email me at DBalasa@aama-ntl.org with questions about specific states. 

On the Job

Permissible Vaccine Administration Sites in South Carolina

I recently received a question asking whether medical assistants are allowed to administer vaccines to patients in a parking lot outside a practice.

Note the italicized and bolded language in the following excerpt from the law enacted by the South Carolina legislature earlier this year:

Section 40-47-196. Delegation of tasks.

(A) Specific tasks may be delegated to a [credentialed medical assistant] by a physician, physician assistant if authorized to do so in [their] scope of practice guidelines, or advanced practice registered nurse if authorized to do so in [their] practice agreement. The scope of practice guidelines for a physician assistant and the practice agreement for an advanced practice registered nurse must address what tasks may be appropriately delegated to a [credentialed medical assistant], provided, however, that the following tasks must not be delegated to a [credentialed medical assistant] by a physician assistant or advanced practice registered nurse:

(1) administering controlled medications, intravenous medications, contrast agents, or chemotherapy agents;

(2) injecting neurotoxin products, neuro modulatory agents, or tissue fillers;

(3) using lasers or instruments that results in tissue destruction;

(4) placing sutures;

(5) taking radiographs or using any ionizing radiation unless the [credentialed medical assistant] is also a certified limited practice radiographer;

(6) analyzing, interpreting, or diagnosing symptoms or tests;

(7) triaging patients; and

(8) performing a clinical decision-making task by means of telemedicine.

(B) A physician, physician assistant, or advanced practice registered nurse may delegate specified tasks to a [credentialed medical assistant] pursuant to the following requirements:

(1) the task must be delegated directly to the [credentialed medical assistant] by the physician, physician assistant, or advanced practice registered nurse, and not through another licensed practitioner;

(2) the task must be performed when the physician, physician assistant, or advanced practice registered nurse delegating the task is in such close proximity as to be immediately available to the [credentialed medical assistant] if needed;

(3) the physician, physician assistant, or advanced practice registered nurse delegating the task must determine that the task is within the training and competency of the [credentialed medical assistant] and will not pose a significant risk to the patient if improperly performed

My legal opinion is that a physician, advanced practice registered nurse, or physician assistant would have to be present in the parking lot and immediately available when a medical assistant is administering vaccines.

The delegating/supervising licensed provider, the medical assistants, and all other health professionals must ensure that required precautions are taken and patient safety is maintained.  All necessary equipment, medication, and other resources should be immediately available in case an emergency occurs.

On the Job, Professional Identity

Only Select Professionals May Legally Use “Nurse” As a Title

I recently received the following significant question about permissible titles:

Recently [someone] was hired in my company, and she is a CMA (AAMA).

Can she call herself a “nurse”? She insisted on getting a name badge that identifies her as a nurse. … I remember being taught we cannot. I found and read the June 2019 article you wrote saying we cannot.

As stated in the 2019 Public Affairs article, the laws in all American jurisdictions continue to forbid anyone—other than registered nurses (RN), licensed practical nurses (LPN), or licensed vocational nurses (LVN)—from calling themself a nurse.

Note the following from a 2019 Advisory Opinion issued by the Kentucky Board of Nursing:

KRS 314.031(1) states: “It shall be unlawful for any person to call or hold [themself] out as or use the title of nurse or to practice or offer to practice as a nurse unless licensed or privileged under the provisions of this chapter.”

Centers for Medicare & Medicaid Services, On the Job

Supervision Requirements for Incident-To Billing

I recently received the following question about incident-to billing: 

My compliance officer asked me to reach out to … seek direction on where we could find current information about [whether] it is permitted to bill incident to when a medical assistant is supervised and billed under a PA [physician assistant] as the supervising physician.

We read your 2016 article … about [Medicare’s Chronic Care Management] and [Transitional Care Management] billing. Oregon recently passed laws where PAs enter into a collaborative agreement with providers. [Does this change whether the Centers for Medicare & Medicaid Services] will now allow incident-to billing with PAs supervising [medical assistants]?

In the Medicare Benefit Policy Manual, the definition of physician includes physician assistants and nurse practitioners. As demonstrated in the 2016 Public Affairs article, medical assistants are classified as auxiliary personnel and clinical staff under Medicare law.

Therefore, medical assistants’ services performed incident to those of a PA may be billed incident to the services of the PA in the same way that they may be billed incident to the services of an MD or DO.