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

Who Is Eligible for an NPI?

Determining who’s eligible for a National Provider Identifier (NPI) number may require some research, which is why, in part, I recently received the following request:

Mr. Balasa, I read with interest the following from your recent post to Legal Eye, “Medical Assistants and Incident-to Billing”:

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.

Could you please provide documentation of which health professionals are and are not eligible for an NPI number?

Medical assistants whose employers request them to get an NPI number may use the following documentation to educate and provide clarity to employers and coworkers.

Note the following from a Centers for Medicare & Medicaid Services (CMS) fact sheet:

  • Who? All individuals and Organizations who meet the definition of health care provider as described at CFR 160.103 are eligible to obtain a National Provider Identifier, or NPI.

Note the following definition from 45 CFR 160.103:

Health care provider means a provider of services (as defined in section 1861(u) of the Act, 42 U.S.C. 1395x(u)), a provider of medical or health services (as defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business.

Section 1861(s) of the Social Security Act does not contain a reference to medical assisting services. It references explicitly the services of the following health professionals:

  • Physicians
  • Nurse practitioners
  • Physician assistants
  • Certified nurse-midwives
  • Qualified psychologists
  • Clinical social workers
  • Certified registered nurse anesthetists

Therefore, according to federal statute and CMS rule, medical assistants are not considered health professionals who are eligible for NPI numbers.

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.

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.

On the Job, Scope of Practice

Scope of Practice near State Borders

I received the following interesting question:

I’m struggling with a difficult question! I am the clinical operations director for a medical group located in Oregon near the Oregon-Washington border. We provide care to Oregon and Washington residents and employ several medical assistants. As you know, Washington law requires certain medical assistants to meet educational and credentialing requirements and to register with the Washington State Department of Health. There are no such requirements for medical assistants under Oregon law.

Do my medical assistants who assist providers treating Washington residents need to meet the medical assisting requirements of the Washington law? All our providers (e.g., physicians, nurse practitioners, physician assistants) are licensed in Oregon.

The following is my response:

Because you are located in Oregon and the providers are licensed under Oregon law, the governing law is that of Oregon. Therefore, your medical assistants are not required to meet the requirements and register with the Washington State Department of Health. It does not matter that some patients are residents of Washington.

However, if your medical group had another location in Washington, the medical assistants would have to meet the requirements of Washington law to work as medical assistants.

medication aide, medication assistant, Scope of Practice

CMAs (AAMA), CNAs, and Medication Aides

I recently received the following question:

Does the law permit a CMA (AAMA) to work as a certified nursing assistant (CNA) in a nursing home without meeting the state requirements for registering as a CNA?

The answer is no. A medical assistant—even a CMA (AAMA) who has graduated from a programmatically accredited medical assisting program—must meet the state requirements for CNAs and register with the state as a CNA in order to perform clinical tasks in a skilled nursing facility or other inpatient settings.

Some states have a category of “medication aides (or assistants).” Medication aides are permitted to distribute medications to patients in an inpatient setting, usually under registered nurse authority and supervision. CMAs (AAMA) must also meet state requirements in order to work as a medication aide.

For more discussion on this topic, read my previous blog post “Medical Assistants and Medication Aides/Assistants/Technicians: Differences and Clarifications.”