Basics of Not-for-Profit and Tax-Exempt Law

The American Association of Medical Assistants® is a not-for-profit corporation, but what does that designation mean and what are the legal requirements that accompany it?  

During telephone presentations to AAMA state societies and local chapters, I discussed various aspects of not-for-profit and tax-exempt law. In the May/June 2021 Public Affairs article in CMA Today, I have adapted these presentations into frequently asked questions. Review the article to learn specifics of not-for-profit and tax-exempt law, such as typical governance documents, tax exemption requirements, and member deductions. 

The article, “Basics of Not-for-Profit and Tax-Exempt Law,” is available on the AAMA website.  

Medical Assistants and Medication Aides/Assistants/Technicians: Differences and Clarifications

Although I have written about the difference between medical assistants and medication aides/assistants/technicians in Public Affairs articles in CMA Today, I continue to receive questions about the topic. Here are the basics:

Medical assistants work in outpatient settings under direct provider supervision, and may be delegated clinical and administrative tasks. Medication aides/assistants/technicians work in inpatient settings, usually under registered nurse supervision. A primary task of medication aides is to pass medications as directed by the RN supervisor.

Medication aides do not exist under the laws of some states. The laws of other states refer to these health workers by a designation other than medication aide. In some states an individual must first meet the requirements and register with the state as a certified nursing assistant (CNA) in order to be eligible to receive additional training and become a medication aide.

Medical assistants do not work in a clinical capacity in inpatient settings as medical assistants per se. Medical assistants must meet the requirements and register with the state as a CNA and/or a medication aide in order to work in a clinical capacity in inpatient settings.

Some state laws refer to medication aides as “certified medication aides.” The initialism associated with this phrase can cause confusion between medical assistants and medication aides. To help minimize such confusion, the National Council of State Boards of Nursing refers to medication aides as “MA-Cs” and encourages states to use this initialism. This change was made at the request of the American Association of Medical Assistants.

“Registered” vs. “Certified”: A Question of Terminology

A common source of confusion within medical assisting is the question of whether medical assisting credentials with “registered” in the name are superior to medical assisting credentials with “certified” in the name.

The answer to this question is no. National medical assisting credentials with the word “registered” as part of the credential name are not of a higher level status than medical assisting credentials with “certified” in their name.

This confusion may be engendered by the fact that “registered” indicates licensed status for credentials in fields other than medical assisting.  For example, in professional nursing, a “registered nurse” is a nurse who has met state educational and testing requirements, and is licensed to practice professional nursing.

However, this is not the case in medical assisting.  A medical assistant with a credential that has “registered” in its title is not in a different or higher legal category than a medical assistant with a credential that has “certified” in its title.

In fact, CMA (AAMA) certification has rigorous college-level education requirements, physician-quality exam standards, and is nationally and globally accredited, unlike other certifications and registrations.

Eligible Professionals in the Medicaid EHR Incentive Program

I would like to note the recent update on eligible professionals (EPs) from the Centers for Medicare & Medicaid Services:

EPs that attest directly to a state for that state’s Medicaid EHR Incentive Program will continue to attest to the measures and objectives finalized in the 2015 EHR Incentive Programs Final Rule (80 FR 62762 through 62955). In 2017, Medicaid EPs have the option to report to the Modified Stage 2 or Stage 3 objectives and measures.

As a reminder, the following are considered to be EPs under the Medicaid Incentive Program:

• Doctors of medicine
• Doctors of osteopathy
• Doctors of dental medicine or surgery
• Nurse practitioners
• Certified nurse midwives
• Physician assistants (PAs) when working at a federally qualified health center or rural health clinic that is so led by a PA

Finally, please note the following language from the 2015 final rule, which is referred to in the previous block quote and is attached at the end of this post:

We are adopting the objective for EPs, eligible hospitals and CAHs [critical access hospitals] as follows:

Objective 4: Computerized Provider Order Entry

Objective: Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who can enter orders into the medical record per state, local, and professional guidelines.

Measure 1: More than 60 percent of medication orders created by the EP or authorized providers of the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry;

• Denominator: Number of medication orders created by the EP or authorized providers in the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
• Numerator: The number of orders in the denominator recorded using CPOE.
• Threshold: The resulting percentage must be more than 60 percent in order for an EP, eligible hospital, or CAH to meet this measure.
• Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period.

Measure 2: More than 60 percent of laboratory orders created by the EP or authorized providers of the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry; and

• Denominator: Number of laboratory orders created by the EP or authorized providers in the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
• Numerator: The number of orders in the denominator recorded using CPOE.
• Threshold: The resulting percentage must be more than 60 percent in order for an EP, eligible hospital, or CAH to meet this measure.
• Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.

Measure 3: More than 60 percent of diagnostic imaging orders created by the EP or authorized providers of the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry.

• Denominator: Number of diagnostic imaging orders created by the EP or authorized providers in the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.
• Numerator: The number of orders in the denominator recorded using CPOE.
• Threshold: The resulting percentage must be more than 60 percent in order for an EP, eligible hospital, or CAH to meet this measure.
• Exclusion: Any EP who writes fewer than 100 diagnostic imaging orders during the EHR reporting period.

Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 Through 2017; Final Rule

Physician Delegation: Standing Orders

Under the laws of most states, physicians are permitted to delegate by means of standing orders to knowledgeable and competent medical assistants as long as the following conditions are met:

1. The standing order is understood by the medical assistant
2. The standing order is for a task that is delegable to medical assistants under the laws of the state, and the delegating physician is exercising the degree of supervision required by the laws of the state
3. The standing order is applicable to all patients without exception
4. The standing order does not require the medical assistant to exercise independent professional judgment, or to make clinical assessments, evaluations, or interpretations