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.

medication administration, On the Job, Professional Identity, Scope of Practice

Preparation and Administration of Injections by Medical Assistants

In the current ambulatory care environment, medical assistants are being delegated the preparation of injectable substances, as well as the administration of injections. I often receive questions about legal restrictions on medical assistants preparing injectable substances. In some states, there are specific laws that address this question. In general, it is my legal opinion that, if there is a likelihood of significant harm to a patient if an injectable substance is prepared improperly, the delegating provider must verify the identity and the dosage of the injectable substance before it is administered by the medical assistant.

medication aide, Scope of Practice

Scope of Practice in Correctional Facilities

The versatility of CMAs (AAMA) is being reflected in the questions I am starting to receive about the scope of practice for medical assistants working in correctional facilities.

If the CMAs (AAMA) are working under direct provider supervision in a clinic within a correctional facility, the standard laws for medical assisting scope of practice apply.  However, if a CMA (AAMA) is functioning as a medication aide and distributing medications under registered nurse supervision (similar to what occurs in a skilled nursing facility or an assisted living facility), the medical assistant would have to meet the state requirements and register with the appropriate state agency as a medication aide.

CPT, CPT codes, delegation, Eligible Professionals, On the Job, Scope of Practice

CMA Today Referenced in Part B News

As many readers of this blog know, I write at length about legal issues affecting the medical assisting profession in each issue of CMA Today, the official publication of the American Association of Medical Assistants. Recently, one of those articles was referenced in a question-and-answer piece in Part B News. (Note: Subscription required.)

The write-up discusses CPT code 69209 (Removal of cerumen using irrigation/lavage) and whether the procedure can be billed if a medical assistant performs it. The author notes several important considerations—for example, the differences in state law and the vagaries of some CPT language—in addition to discussing the CPT definition of “clinical staff” as it relates to medical assistants. Ultimately, the author states the following:

In aggregate, when it comes to medical assistants being eligible to perform services incident to a physician, the answer is “generally yes,” according to recent guidance from the American Association of Medical Assistants (AAMA).

The language the author cited was from my article “‘Incident-to’ billing: Medical assistants’ services under the Medicare CCM program,” which can be found on the AAMA website.