delegation, Medicare, On the Job, Scope of Practice

Medical Assistants and the Medicare Annual Wellness Visit

There seems to be some confusion about what a medical assistant is permitted to do in connection with a Medicare Annual Wellness Visit (AWV). Let’s start with a description of a Medicare AWV from the May/June 2015 CMA Today article “Prioritizing Prevention: Medicare’s Annual Wellness Visit”:

The yearly wellness visit provides seniors with a general health-risk assessment that includes screenings for depression, cognitive impairment, and other health concerns. At the visit, health care providers review the patient’s medical and family history, docu­ment vital measurements, such as height, weight, and blood pressure, and update lists of current providers and prescriptions. At the conclusion of the visit, the patient is provided with a personal health plan, including a long-term schedule for future screenings and preventive services.

Note the following document from the Centers for Medicare & Medicaid Services (CMS), “The ABCs of the Annual Wellness Visit”:

Medicare Part B covers an AWV if performed by a:

  • Physician (a doctor of medicine or osteopathy)
  • Qualified non-physician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist)
  • Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals who are directly supervised by a physician (doctor of medicine or osteopathy)

It is my legal opinion that federal law permits medical assistants to assist licensed health care providers (e.g., MDs/DOs, nurse practitioners, physician assistants) in the performing of an AWV. However, medical assistants are not permitted to perform any part of the AWV that requires the medical assistant to make independent clinical judgments or to make clinical assessments or evaluations.

Certification and the CMA (AAMA) Credential, Scope of Practice

Can CMAs (AAMA) Be Ophthalmic Technicians, and Vice Versa?

Often the questions I receive from CMAs (AAMA) are as versatile as the health professionals asking them. Although some questions focus on an individual’s specific circumstance, they present a situation all CMAs (AAMA) with certification questions can learn something from. The following question is one such case:

I would like to know if a CMA (AAMA) is permitted to work at the office of an ophthalmologist as an ophthalmic technician and be able to continue to hold and recertify the CMA (AAMA) credential.

The answer to your question is yes. One of the many advantages of the CMA (AAMA) is the variety of professional opportunities that are available. CMAs (AAMA) work in the offices of ophthalmologists in various capacities.

The Certifying Board of the AAMA places no restrictions on the types of positions CMAs (AAMA) must hold in order to be eligible to recertify. You are permitted to work as an ophthalmic technician and recertify your CMA (AAMA) by continuing education or retesting.

delegation, Scope of Practice

Duties and Delegation Abroad

I field many scope-of-practice questions in my work, some of which are highly specific to the individuals posing them. Others can be applied more broadly, however. These serve as interesting material to share with readers of this blog. The following is one such question I received recently.

I practice as a medical assistant in North Carolina. I routinely travel outside the country for medical missions. As a CMA (AAMA), when working under a physician licensed in another country, am I permitted to perform the same tasks that I am allowed to perform under North Carolina law?

I responded as follows:

Thank you for your most interesting question.  Your legal scope of practice would depend on the laws of the country in which you are working.  You would not necessarily be able to perform the same tasks you are delegated in North Carolina.

However, to take your question a step further, it is my legal opinion that—if a physician licensed in North Carolina also went on such a mission trip—the physician would be permitted to delegate to you the same tasks that he/she delegates to you under North Carolina law.  This same legal principle would apply to nurse practitioners and physician assistants licensed in North Carolina.

Note that the state in question here is largely interchangeable. Were the medical assistant and physician from Oklahoma, for example, the same legal principle would apply, only specific to Oklahoma law instead of North Carolina.

delegation, Scope of Practice

The Relationship between Scope and Competence

Medical assistants are under a legal duty to not exceed the legal scope of practice in their state.  Medical assistants are also under a legal duty to perform all tasks competently.  It is important to understand the relationship between these two legal duties.

Even if a medical assistant performs a task competently, and meets or exceeds the standard of care that is required of a medical assistant, the medical assistant could face legal sanctions if the task is beyond the legal scope of practice for medical assistants in the state.

Similarly, if a medical assistant performs a task that is permitted under state law, the medical assistant (and, most likely, the medical assistant’s delegating provider) could be sued for negligence if the task is not performed competently.

Medical assistants must make sure they perform all tasks competently.  They must also make sure that the tasks they perform do not exceed the legal scope of practice in the state (or other American jurisdiction) in which they are working. Of course, the best way to do so is by remaining informed about the laws in your own state. To help health care professionals navigate this issue, the AAMA website has a large collection of documents relating to different states’ scope of practice laws. Any medical assisting scope of practice questions that are not covered by these materials can be emailed to me at dbalasa@aama-ntl.org.

delegation, On the Job, Professional Identity, Scope of Practice

Medical Assistants and Limited Scope Radiography

I receive fewer questions than I did seven or 10 years ago about the legalities of medical assistants performing limited scope radiography. However, in some states medical assistants are called upon to expose patients to ionizing radiation, as specifically directed by the overseeing/delegating provider.

The legality of this task is governed by state law. In some states unlicensed professionals such as medical assistants are forbidden from doing any limited scope radiography. Only licensed radiologic technologists are permitted to perform radiography. In other states medical assistants are required to complete a short course and pass a test in order to be delegated limited scope radiography. In other states limited scope radiography under direct/on-site provider supervision is not regulated. Physicians are permitted to delegate limited scope radiography to knowledgeable and competent employees.