On the Job, Scope of Practice

Scope of Practice near State Borders

I received the following interesting question:

I’m struggling with a difficult question! I am the clinical operations director for a medical group located in Oregon near the Oregon-Washington border. We provide care to Oregon and Washington residents and employ several medical assistants. As you know, Washington law requires certain medical assistants to meet educational and credentialing requirements and to register with the Washington State Department of Health. There are no such requirements for medical assistants under Oregon law.

Do my medical assistants who assist providers treating Washington residents need to meet the medical assisting requirements of the Washington law? All our providers (e.g., physicians, nurse practitioners, physician assistants) are licensed in Oregon.

The following is my response:

Because you are located in Oregon and the providers are licensed under Oregon law, the governing law is that of Oregon. Therefore, your medical assistants are not required to meet the requirements and register with the Washington State Department of Health. It does not matter that some patients are residents of Washington.

However, if your medical group had another location in Washington, the medical assistants would have to meet the requirements of Washington law to work as medical assistants.

On the Job, Scope of Practice

Medical Assistants in Camping Settings

I recently received the following question:

I was wondering whether medical assistants in my state are eligible to become overnight camp health officers and whether we are allowed to give intramuscular and subcutaneous injections as needed. No health care provider would be physically present. However, one or more providers (e.g., physicians, nurse practitioners, physician assistants) would be available by phone.

Under the laws of your state, medical assistants are not permitted to serve as camp health officers when no licensed health care provider is present and immediately available. This is because health professionals in a camping setting may be called upon to deal with situations that require the making of immediate clinical assessment and evaluations and the exercise of independent clinical judgments. Medical assistants are not taught the knowledge and skills necessary to function in this capacity.

Medical assistants are permitted to assist licensed health care providers in a camping environment, however.

delegation, Scope of Practice

Duties and Delegation Abroad

I field many scope-of-practice questions in my work, some of which are highly specific to the individuals posing them. Others can be applied more broadly, however. These serve as interesting material to share with readers of this blog. The following is one such question I received recently.

I practice as a medical assistant in North Carolina. I routinely travel outside the country for medical missions. As a CMA (AAMA), when working under a physician licensed in another country, am I permitted to perform the same tasks that I am allowed to perform under North Carolina law?

I responded as follows:

Thank you for your most interesting question.  Your legal scope of practice would depend on the laws of the country in which you are working.  You would not necessarily be able to perform the same tasks you are delegated in North Carolina.

However, to take your question a step further, it is my legal opinion that—if a physician licensed in North Carolina also went on such a mission trip—the physician would be permitted to delegate to you the same tasks that he/she delegates to you under North Carolina law.  This same legal principle would apply to nurse practitioners and physician assistants licensed in North Carolina.

Note that the state in question here is largely interchangeable. Were the medical assistant and physician from Oklahoma, for example, the same legal principle would apply, only specific to Oklahoma law instead of North Carolina.

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.

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.