dental assistant, On the Job, Scope of Practice

Medical Assistants Working with Dually Licensed Providers

The following question is not asked frequently. However, it raises important legal considerations:

I work for an oral surgeon who is both a licensed physician and a licensed dentist. Is my scope of practice determined by the state medical practice act or the state dental practice act?

Many oral surgeons have both an MD/DO degree (doctor of medicine or osteopathy) and a DDS/DMD degree (doctor of dental surgery or dental medicine) and are licensed as both physicians and dentists.

When medical assistants perform a dental task, they function as dental assistants. Thus, the state dental practice act and the regulations and policies of the state board of dental examiners determine the legal scope of practice—including supervision requirements by the delegating oral surgeon. If state law allows delegation of certain dental tasks only to individuals who meet dental assisting education and credentialing requirements, medical assistants must meet these requirements or obtain a waiver from the board of dental examiners to perform such tasks.

When medical assistants perform a medical task, the scope of practice is established by the state medical practice act and the regulations and policies of the state board of medical examiners. Go to the State Scope of Practice Laws webpage on the AAMA website to find the medical assisting law of all states.

Certification and the CMA (AAMA) Credential, On the Job, Professional Identity

“Certified Medical Assistant” vs. “Medical Assistant-Certified” in Washington: A Review of Permissible Usage among Programs

The distinction between “certified medical assistant” and its variations can be difficult for medical assisting programs to make. Trademark registrations and state law need to be taken into consideration.

Take this question for example:

Can a Washington-based medical assisting program that meets the requirements of the Washington State Department of Health (e.g., graduates can become a “medical assistant-certified” [MA-C]) but not the CMA (AAMA)® Certification Exam use the phrase “certified medical assistant” in connection with their program?

The American Association of Medical Assistants® (AAMA) holds a trademark registration with the U.S. Patent and Trademark Office for the phrase “certified medical assistant.” Any party’s use of the phrase that is likely to confuse or mislead the public is an infringement of the AAMA’s intellectual property rights in the phrase.

Medical assisting programs that are not accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) should not use the phrase because it could be misconstrued as their graduates being eligible for the CMA (AAMA) Certification Exam.

Washington State Legislature has established several categories for medical assistants (WAC 246-827-0010), but the medical assistant-certified (MA-C) category is the one most likely to be confused with “certified medical assistant” permissible usage. Note the requirements for becoming an MA-C:

WAC 246-827-0200

Medical assistant-certified—Training and examination.

An applicant for a medical assistant-certified credential must meet the following requirements:

(1) Successful completion of one of the following medical assistant training programs:

(a) Postsecondary school or college program accredited by the Accrediting Bureau of Health Education Schools (ABHES) or the Commission of [sic] Accreditation of Allied Health Education Programs (CAAHEP);

(b) Postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education, which includes a minimum of seven hundred twenty clock hours of training in medical assisting skills, including a clinical externship of no less than one hundred sixty hours;

(c) A registered apprenticeship program administered by a department of the state of Washington unless the secretary determines that the apprenticeship program training or experience is not substantially equivalent to the standards of this state. The apprenticeship program shall ensure a participant who successfully completes the program is eligible to take one or more examinations identified in subsection (2) of this section; or

(d) The secretary may approve an applicant who submits documentation that he or she completed postsecondary education with a minimum of seven hundred twenty clock hours of training in medical assisting skills. The documentation must include proof of training in all of the duties identified in RCW [Revised Code of Washington] 18.360.050(1) and a clinical externship of no less than one hundred sixty hours.

(2) Pass a medical assistant certification examination, approved by the secretary, within five years of submitting an initial application. A medical assistant certification examination approved by the secretary means an examination that:

(a) Is offered by a medical assistant program that is accredited by the National Commission for Certifying Agencies (NCCA); and

(b) Covers the clinical and administrative duties under RCW 18.360.050(1).

Consequently, if the medical assisting program meets (1)(a), (b), (c), or (d), it would be permissible for the program to state that graduates meet the educational portion of the MA-C requirements. It would also be permissible to state that graduates would be eligible for one or more of the NCCA-accredited medical assisting certification programs.

For more information on whether a Washington-based MA-C can write “CMA” after their name, see my blog post “Can Washington State Medical Assistants Use the ‘CMA’ Initialism?

Accreditation, Certification and the CMA (AAMA) Credential

Medical Assisting Programs Should Maintain Programmatic Accreditation

Since the announcement of the CMA (AAMA)® Certification Exam Eligibility Pilot Program, many people have had questions concerning its rationale and ramifications. Take the following set of questions for example:

This new pilot program has North Carolina educators in deep discussion. I wanted to clarify a few items before presenting this new pilot program to my advisory board:

  1. What is the benefit of programs to maintain accreditation if students can sit for the CMA (AAMA) Certification Exam in a nonaccredited program?
  2. When students find out about this pilot program, retention rates could be affected. Is the AAMA prepared to address this issue? I can imagine that curriculum revisions will be increasing. Our college administration has insisted that we offer a one-year diploma that is not accredited to offer students the opportunity to complete faster. 
  3. Is the pilot program expected to be available for three years?

Those are great questions. Medical assisting programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) should maintain their programmatic accreditation because state boards of medical examiners and state boards of nursing have established education and/or credentialing requirements for medical assistants who are delegated the administration of medication by physicians, physician assistants, and advanced practice registered nurses (APRNs), especially nurse practitioners.

Note the following requirements for medical assistants to be registered, and therefore permitted to work as medical assistants, from the joint rules of the South Dakota Board of Nursing and the South Dakota Board of Medical and Osteopathic Examiners:

20:84:04:01. Approved education programs. An applicant for registration shall have graduated from a medical assistant program that is approved by the boards or accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), or a similar accrediting institution approved by the United States Department of Education. Approved programs must provide classroom, laboratory, and clinical learning experiences that provide for student attainment of entry-level competence as a registered medical assistant.

The number of CAAHEP- and ABHES-accredited medical assisting programs—and the number of their graduates—has decreased in the last five years. Some programs have closed, and some continue to offer a medical assisting program but have discontinued their programmatic accreditation.

However, anecdotal evidence is emerging that accredited medical assisting programs that have articulation agreements with other allied health programs are experiencing stable if not increasing enrollment in their medical assisting programs.

And yes, the CMA (AAMA) Certification Exam Eligibility Pilot Program will be available for three years, which began in August 2019. For more information, visit the Eligibility Pilot Program webpage on the AAMA website.

Centers for Medicare & Medicaid Services, delegation, On the Job, Professional Identity

Appropriate Use Criteria Program: CMAs (AAMA)® Meet Clinical Staff Criteria under the CMS Rule

In the Public Affairs article of the March/April 2018 CMA Today, I argued that “appropriately educated and credentialed medical assistants” such as CMAs (AAMA)® are clinical staff under the Medicare Chronic Care Management (CCM) and Transitional Care Management (TCM) programs.

I now add that CMAs (AAMA) are also clinical staff according to the Centers for Medicare & Medicaid Services (CMS) rule regarding the appropriate use criteria (AUC) program. Therefore, as a result of their clinical staff status, I assert that CMAs (AAMA) are permitted to do the following:

  1. Consult a clinical decision support mechanism (CDSM) about the appropriateness of ordering a particular advanced diagnostic imaging service
  2. Report findings to their overseeing or delegating licensed providers

Review the supporting evidence in the September/October 2019 Public Affairs article, “Appropriate Use Criteria Program,” on the AAMA website.

On the Job, Professional Identity

Permissible Initialisms for Student Medical Assistants

It is legally inadvisable for student medical assistants who are on their externship/practicum to include any unrecognized initialism, such as the initials “SMA” (for “Student Medical Assistant”), after their names. Because “SMA” is not a recognized credential for medical assistants and there is no recognized credential given to medical assisting students just for being a student, externing students who insert any initialism after their names could cause confusion.

Using an unrecognized credential is an important issue for the medical assisting profession because of the large number of credentials and initialisms that currently exist in medical assisting.

If a practicum site strongly prefers that the externing medical assisting students identify themselves in some distinctive way, it would be preferable to have the students use the phrase “Student Med Asst” or some other type of designation.