medication aide, medication assistant, medication technician, Uncategorized

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.

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.

delegation, dental assistant, On the Job, Professional Identity, Scope of Practice

Medical Assistants in Dental Offices

This blog frequently discusses scope-of-practice issues, but health care always provides new questions to examine. This post will address the following: Are medical assistants permitted to work in a dental office under the authority/supervision of a dentist?

First of all, it is important to keep in mind the distinction between a dental hygienist and a dental assistant. Under the laws of all American jurisdictions, dental hygienists are required to be licensed. Licensure for dental hygienists requires graduation from a postsecondary dental hygiene academic program and the passing of a national (and in some cases, state) examination. Thus, medical assistants—including CMAs (AAMA)—are not permitted to work as dental hygienists.

Under the laws of some states, dental assistants are required to have formal education and pass a test in order to be delegated certain tasks by the overseeing/delegating dentist. Other states have no educational or testing requirements for dental assistants. A medical assistant should check with the state board of dental examiners (usually in the state capital) to find out whether the state has any educational or testing requirements for dental assistants, and whether any of the medical assisting education or credentialing can be used toward meeting any state requirements for dental assistants.

Certification and the CMA (AAMA) Credential, CMS Rule, Computerized Provider Order Entry (CPOE), EHR Incentive Programs, Meaningful Use, On the Job, Scope of Practice

AAMA Submits Comments on Stage 3 Final Rule

In its efforts to stay abreast of state and federal laws pertaining to the medical assisting profession, the AAMA recently submitted comments to the Centers for Medicare and Medicaid Services regarding some specific language from the October 16, 2015 Federal Register. What follows are those comments.

The following comments are being submitted on behalf of the American Association of Medical Assistants (AAMA), the national organization representing the medical assisting profession at the federal and state levels.

There appears to be an accidental inconsistency between the following language on page 62944 of the final rule, and the following language on pages 62949 and 62950 of the final rule:

Page 62944, third column:

(3) Computerized provider order entry. (i) Objective. Use computerized provider order entry for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

Page 62949, third column, and page 62950, first column:

(4) Computerized provider order entry (CPOE).—(i) EP CPOE—(A) 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. …

(ii) Eligible hospital and CAH CPOE—(A) 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.

The American Association of Medical Assistants believes that there is an inconsistency between the above excerpts because of the following language in the analysis of, and responses to, public comments:

Page 62798, second column:

Response: In the Stage 2 final rule (77 FR 53986) and in subsequent guidance in FAQ 9058,6 we explained for Stage 2 that a licensed health care provider or a medical staff person who is a credentialed medical assistant or is credentialed to and performs the duties equivalent to a credentialed medical assistant may enter orders. We maintain our position that medical staff must have at least a certain level of medical training in order to execute the related CDS for a CPOE order entry. We defer to the provider to determine the proper credentialing, training, and duties of the medical staff entering the orders as long as they fit within the guidelines we have proscribed. We believe that interns who have completed their medical training and are working toward appropriate licensure would fit within this definition. We maintain our position that, in general, scribes are not included as medical staff that may enter orders for purposes of the CPOE objective.

However, we note that this policy is not specific to a job title but to the appropriate medical training, knowledge, and experience.

Page 62839, first column:

Response: As noted in the Stage 3 proposed rule (80 FR 16751), we require that the person entering the orders be a licensed health care professional or credentialed medical assistant (or staff member credentialed to the equivalency and performing the duties equivalent to a medical assistant). We defer to the provider’s discretion to determine the appropriateness of the credentialing of staff to ensure that any staff entering orders have the clinical training and knowledge required to enter orders for CPOE.

The American Association of Medical Assistants therefore recommends that the above language on page 62944, third column, be expanded to include “credentialed medical assistants,” as do the above excerpts from page 62949, third column, and page 62950, first column.

Certification and the CMA (AAMA) Credential, delegation, medication administration, On the Job, Professional Identity, Scope of Practice

Medical Assistants as Pharmacy Technicians

I have been receiving an increasing number of questions similar to the following:

Can a CMA (AAMA) work as a pharmacy technician in my state?  And, if so, can that CMA (AAMA) administer injections and take blood pressures under the supervision of a pharmacist?

Here is my response:

Thank you for this question.  A medical assistant—even a CMA (AAMA)—would have to meet the state law requirements and become a pharmacy technician in order to work in that capacity under the supervision of a pharmacist.  Once a CMA (AAMA) is registered by the state as a pharmacy technician, the scope of practice for this individual would be the same as all other pharmacy technicians as specified by the laws of that state.