Scope of Practice

Permissible Supervision Duties for North Carolina Medical Assistants

I recently received the following question:

[In North Carolina,] can a CMA (AAMA) be a supervisor over LPNs [licensed practical nurses] and RNs [registered nurses], as well as CMAs (AAMA)?

 To answer this question, note the following information from the “Frequently Asked Questions” webpage on the North Carolina Board of Nursing website:

Can a nurse be supervised by an unlicensed person or another discipline?

A non-nurse (other than a licensed physician) may not supervise nursing practice but could supervise basic employment issues (i.e., administrative supervision, human resource issues [such as] time, attendance, [and] dress code).

Certification and the CMA (AAMA) Credential

The Misuse of Medical Assisting Credentials May Have Legal Consequences

The roles of medical assistants have expanded and diversified during the last 10 years. So too have the number and types of medical assisting credentials. In this blog post, I will explain basic facts about medical assisting credentials and the potential legal consequences of misusing them.

Licensing and Certification

A license is a mandatory credential, usually issued by a state, without which an individual is not permitted by law to practice a profession. A certification is most frequently a voluntary credential, usually issued by a private-sector body, that provides evidence of an individual’s knowledge and competence in a profession. A license is required by law; a certification is (with limited exceptions) not required by law.

Examples of medical assisting licenses are the “medical assistant-certified (MA-C)” and the “medical assistant-registered (MA-R)” issued by the Washington State Department of Health.

Accreditation of Certification Programs

There are two accreditations available to U.S. certification programs:

  • Accreditation by the National Commission for Certifying Agencies (NCCA) under its Standards for the Accreditation of Certification Programs
  • Accreditation under International Standard ISO/IEC 17024:2012, Conformity Assessment—General Requirements for Bodies Operating Certification of Persons (ISO 17024)

Accreditation of the CMA (AAMA) Certification Program

The CMA (AAMA)® is a medical assisting certification issued by the Certifying Board of the American Association of Medical Assistants® (AAMA). The CMA (AAMA) certification program is the only medical assisting certification program that is accredited both by the NCCA and under ISO 17024.

Permissible Use of the CMA (AAMA) Credential

The only medical assistants permitted to use the CMA (AAMA) designation in connection with employment or seeking employment are those medical assistants who have achieved certification through the Certifying Board of the American Association of Medical Assistants (AAMA) and whose CMA (AAMA) credential is current. A medical assistant who never held the CMA (AAMA) or who formerly held the CMA (AAMA) but whose CMA (AAMA) is not current is forbidden from using the CMA (AAMA) credential. A medical assistant who violates this policy is in jeopardy of sanctions by the Certifying Board of the AAMA and sanctions under federal trademark law.

Registration of the CMA (AAMA)

The AAMA registered the “CMA (AAMA)” designation/initialism with the United States Patent and Trademark Office (USPTO) as a certification mark. This registration gives the AAMA intellectual property rights in this designation. A certification mark “is a type of trademark that is used to show consumers that particular goods and/or services, or their providers, have met certain standards,” according to the USPTO.

Registration of the “Certified Medical Assistant” Phrase

The three-word phrase “certified medical assistant” has also been registered by the AAMA with the USPTO. Consequently, this three-word phrase should not be used as a generic reference to all medical assistants. This phrase should also not be used as a generic reference to all medical assistants who hold a credential. “Certified medical assistant” should only be used when referring to medical assistants who hold a current CMA (AAMA).

The Legal Status of the “CMA” Initialism

The “CMA” initialism is not registered with the USPTO. This is because the official designation of the credential awarded by the Certifying Board of the AAMA was changed from “CMA” to “CMA (AAMA),” effective January 1, 2008. However, the AAMA retains common law rights in the initialism “CMA.” For example, if the initialism “CMA” were used in a way that would likely confuse employers or other parties into thinking that the reference to “CMA” was a reference to “CMA (AAMA),” the AAMA would likely have a cause of action against the misusing party.

State Law Authorizing the Use of “CMA” as an Abbreviation of “Certified Medication Aide/Assistant”

Statutes or regulations of some states permit or require the initialism “CMA” to be used as the designation for “certified medication aides” or “certified medication assistants.” Such state laws do not infringe the AAMA’s common law rights in the “CMA” initialism because the authority of a government to define an initialism and restrict its use supersedes the authority of a private-sector body—such as a certifying board—to do so. In fact, in some states it is a violation of state law to use “CMAs” to refer to medical assistants rather than medication aides. This is another example of negative legal consequences resulting from the misuse of a credential.

State Law Requiring Words or Initials to Be Used on Medical Assistants’ Name Tags

Some states’ laws require words or initialisms to be on the name tags of medical assistants. These laws must be obeyed. If they are not, legal sanctions may result.

The Display of Medical Assisting Credentials in EHR Platforms

Employers will sometimes tell medical assistants that the electronic health record (EHR) platform of the clinic, practice, or health system will not permit the inclusion of medical assistants’ credentials. This is usually not the case. Most EHR platforms have this capability.

Questions should be directed to me in the comments or via email at

Centers for Medicare & Medicaid Services, CMS Rule, Scope of Practice

Testing Period Extension for the AUC Program

Note the recent update via the Centers for Medicare & Medicaid Services on the appropriate use criteria (AUC) program:

NOTICE: The EDUCATIONAL AND OPERATIONS TESTING PERIOD for the AUC Program has been extended through CY 2021. There are no payment consequences associated with the AUC program during CY 2020 and CY 2021. We encourage stakeholders to use this period to learn, test and prepare for the AUC program.

The following describes the intended AUC program timeline, according to the Centers for Medicare & Medicaid Services:

Program Timeline

Currently, the program is set to be fully implemented on January 1, 2022 which means AUC consultations with qualified CDSMs [clinical decision support mechanism] are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid. Prior to this date the program will operate in an Education and Operations Testing Period starting January 1, 2020 during which claims will not be denied for failing to include proper AUC consultation information. Beginning July 1, 2018 the program is operating under a voluntary participation period during which time consultations with AUC may occur and may be reported on furnishing professional and facility claims using HCPCS [Healthcare Common Procedure Coding System] modifier QQ.

As a reminder, I provide supporting evidence for my position that CMAs (AAMA) are clinical staff according to the Centers for Medicare & Medicaid Services rule regarding the AUC program in my Public Affairs article of the September/October 2019 CMA Today. 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

Find the article, as well as all my other Public Affairs articles, on the AAMA website.

Certification and the CMA (AAMA) Credential

Who Can Take the CMA (AAMA)® Exam?

Q. Who is eligible to take the CMA (AAMA)® Certification Exam?

A. The only individuals eligible to take the CMA (AAMA) Certification Exam and become CMAs (AAMA) are graduates or graduating students of medical assisting programs that fall within one of the following categories:

  • Accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP)
  • Accredited by the Accrediting Bureau of Health Education Schools (ABHES)
  • Meets the criteria for the time-limited Certification Exam Eligibility Pilot Program

The Certification Exam Eligibility Pilot Program is a three-year pilot program, begun August 2019, that allows graduates of postsecondary (college-level) medical assisting programs to take the CMA (AAMA) Exam if the program meets certain requirements, including the program being part of an institution accredited by an accrediting body recognized by either the United States Department of Education (USDE) or the Council for Higher Education Accreditation (CHEA).

Hopeful exam candidates can gather all required documentation and submit their documentation for review—to see if they are eligible under the pilot program—for free online via the AAMA website.

Certification and the CMA (AAMA) Credential

The CMA (AAMA)® Certification Exam Eligibility Pilot Program

The Certifying Board (CB) of the American Association of Medical Assistants® (AAMA) has approved the launch of a three-year eligibility pilot program, which temporarily opens a new education pathway for medical assistants to become eligible to sit for the CMA (AAMA)® Certification Exam.

Applicants first submit their documentation for review, free of charge, to determine their eligibility to apply for the exam. The criteria and submission requirements for the review are outlined on the Eligibility Pilot Program webpage of the AAMA website.

Before implementing the program, the CB took into account several policy priorities, including but not limited to the following:

  • Maintaining global and national accreditation standards
  • Heeding a recommendation from the National Commission for Certifying Agencies
  • Needing to collect and evaluate empirical evidence on examination performance by candidates who are not graduates of accredited medical assisting programs

Examine all the CB’s considerations and rationale in detail by reading the November/December 2019 Public Affairs article, “The CMA (AAMA)® Certification Exam Eligibility Pilot Program: Criteria and Rationale for the Three-Year Pilot Study,” on the AAMA website.