Affordable Care Act (ACA), EHR Incentive Programs, Meaningful Use, Medicaid, Medicare, Scope of Practice

Congressional Action on the ACA

As our government transitions to a new administration, the following question has become increasingly common:

Would amendments to or repeal of the Affordable Care Act (ACA) affect medical assistants’ scope of practice?

The answer? Almost certainly not.  The scope of practice of medical assistants is determined primarily by state law.  An exception is the meaningful use order entry requirements of the Medicaid Electronic Health Record Incentive Program.  The Medicaid Incentive Program was not created by the ACA and would not be impacted by any amendments to or repeal of the Affordable Care Act.  Consequently, it is highly unlikely that the scope of practice for medical assistants will be impacted by congressional action on the ACA.

Centers for Medicare & Medicaid Services, Computerized Provider Order Entry (CPOE), EHR Incentive Programs, On the Job

MACRA and Order Entry Requirements

The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA) mandated that the Medicare Electronic Health Record (EHR) Incentive Program come to an end on December 31, 2016. One of the new payment mechanisms for Medicare established by MACRA is the Merit-Based Incentive Payment System (MIPS). Under the primary reporting method of MIPS, an eligible provider is not required to report to the Centers for Medicare & Medicaid Services (CMS) that medication, laboratory, and diagnostic imaging orders are being entered by credentialed medical assistants or licensed health care professionals.

CMS, however, offers eligible providers an alternate reporting method under MIPS. Under this method, providers are permitted to report on optional measures, such as computerized provide order entry (CPOE).

This issue will be addressed in greater detail in the upcoming January/February 2017 issue of CMA Today. In the meantime, all past Public Affairs articles by CEO Balasa can be found on the AAMA website

delegation, On the Job, Scope of Practice, Uncategorized

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
Computerized Provider Order Entry (CPOE), EHR Incentive Programs, Eligible Professionals, Medicaid, On the Job

Order Entry Requirements for Non-Physician Practitioners

I was recently asked whether non-physician practitioners (e.g., nurse practitioners and physician assistants) must meet the meaningful use order entry requirements under the Medicaid Electronic Health Record (EHR) Incentive Program.  The answer is yes.

The following are considered “eligible professionals” (EPs) who can participate in the  Medicaid EHR Incentive Program:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioners
  • Certified nurse-midwives
  • Dentists
  • Physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant

All participating EPs must meet the computerized provider order entry (CPOE) requirements of the Incentive Program in order to receive incentive payments.

On the Job, Professional Identity, Scope of Practice

Medical Assisting across State Lines

I recently received the following two questions:

  1. Is a medical assistant permitted to cross state lines and work in two different states at the same time?
  2. Are there any CMAs (AAMA) working as “traveling medical assistants,” similar to “traveling RNs”?

 

A medical assistant is permitted to work in two different states as long as the medical assistant is abiding by the medical assisting laws in both states, and meets any credentialing requirements in the two states.

There is nothing in the laws of any state that forbids a medical assistant from working for more than one employer.  If that is your definition of a “traveling medical assistant,” it is permissible for a CMA (AAMA) to work in in this capacity.