MAST Ten Ten Law Class - Chapters 1-5

Healthcare Team

• Employees in a corporation or collaboration should work as a team to provide the best healthcare to clients.
• Teamwork involves both leaders and followers working together.
• Healthcare professionals must follow the regulations of the state they are employed in.
• State guidelines take precedence over credentialing bodies and employers.

Credentialing

• Certification:
  • An example is a medical assistant.Professional organizations administer national exams to assess knowledge and skills.
  • Passing the exam demonstrates meeting minimum standards set by the organization (e.g., CAHIP standards).
  • Certification is generally not specialty-specific.
  • Certification is a self-regulating, voluntary process.
  • Certification enables medical assistants to work on computers due to knowledgeable use as permitted by CMS.
• Registration:
  • Another form of credentialing.
• Licensure:
  • It is the strongest form of regulation.
  • Requires passing an exam and paying a fee.
  • License verifies that the employee meets minimum standards required by law.
  • Licenses are obtained from the state of employment.
• Continuing Education:
  • CEUs are required for renewal.
  • Renewal involves a fee and proof of completing CEUs within a specific timeframe (e.g., two to five years).

Administrative Staff

• Administrative staff typically work in the front office.
• Responsibilities: answering phones, filing, billing, checking in/out patients.
• In some areas, medical assistants may work in the front office.
• Roles: insurance specialists, coders, billers, file clerks.
• Certificates can be obtained for specialized roles.

Medical Assistant Designations

• Graduate Medical Assistant (MA)
• Certified Medical Assistant (CMA): CMA (AAMA)
• Registered Medical Assistant (RMA)
• Certified Medical Administrative Specialist (CMAS): Not CMAs, but CMAS. Focuses on front office tasks.

KHEP and AAMA

• KHEP has over 600 programs
• AAMA is the association through which one can take the national certification exam to become a CMA.

ABHES and AMT

• ABHES has 29 programs.
• Through AMT, candidates can take the national certification exam to become an RMA or CMAS.

CEU Requirements

• AAMA (CMA): 60 CEUs every five years
• AMT (RMA/CMAS): 30 CEUs every three years

Definition of MAs by AAMA

• Medical assistants are the only allied health professionals specifically trained to work in ambulatory care settings like physicians' offices, clinics, and group practices.
• They are multiskilled personnel capable of performing administrative and clinical procedures.
• Physicians value their versatility as managed care emphasizes cost containment and efficient human resource management.
• The demand for MAs is expanding.
• Training includes both administrative and clinical practices.
• Certification is advantageous due to knowledgeable use requirements and employer expectations for EHR/EMR access.

Accreditation

• Graduates from accredited programs (KHEP or ABHES) can take the national certification exam.
• Passing the exam leads to CMA (via AAMA) or RMA (via AMT) certification.
• The RMA requires 30 CEUs every three years for recertification.
• CMA requires renewal every 60 months with 60 CEUs.

Certified Medical Administrative Specialist (CMAS)

• Offered by AMT.
• CMAS professionals are familiar with clinical and technical concepts needed for the front office.
• This role is commonly held by clinic managers or practice managers who oversee the daily operations of the clinic site.

Accreditation of Medical Assisting Programs

• KHEP can award or deny accreditation.
• AAMA collaborates with AMA.
• Graduates of KHEP-accredited programs are eligible to sit for the national certification exam.
• KHEP sets standards, including required competencies that must be met to progress in the program.

Medical Coding

• Medical professional coders ensure correct application of procedure, supply, and diagnostic codes for billing medical services.
• Two professional coder associations: AAPC and AHIMA.
• These associations certify coders.
• Medical coding programs are designed for medical assistants to gain coding qualifications.

Clinical Support Team

• Some states limit the scope of practice for MAs (e.g., prohibiting vaccinations).
• MAs must be aware of state laws governing their practice.
• Medical Laboratory Technicians (MLTs) prepare specimens and operate automated analyzers in on-site labs.
• Medical Technologists (MTs) work in clinical pathology labs, running blood and tissue tests, and analyzing biological samples.
• LPNs and RNs also have defined scopes of practice.
• State regulations dictate what healthcare professionals can do within their scope of practice.

Endorsement/Reciprocity

• It occurs when one state recognizes the licensing procedures of another state.
• The state considers it valid and grants a license to practice based on the other's licensure.

Health Care Providers

• Physician's Assistants (PAs) can be certified, registered, or licensed.
• Nurse Practitioners (NPs) typically have a four-year BSN degree, followed by a master's or doctoral program.
• NPs typically work similarly to PAs.

Considerations for Ambulatory Care Employers

• Due to the ever-changing field of medicine, continual education is important.
• Employers need to ensure employees are up to date on credentialing.
• A clinic manager typically manages credentialing using a reminder system (tickler file).
• The office manager maintains records of CPR certification, bloodborne pathogen training, and credentials.
• Reminders are issued six months before credential expiration to allow time for renewal.

Scope of Practice

• State regulations vary and change as medicine becomes more specialized.
• Medical practice acts are state laws defining the scope of practice for healthcare professionals.
• Scope of practice is used by state licensing boards to determine permissible procedures, actions, and processes based on experience, education, and competency.
• The scope of practice varies among healthcare professional categories and even within specific categories from state to state.
• LPNs, RNs, MAs, and physicians all have a defined scope of practice.

MA Scope of Practice

• In some states, MAs cannot perform venipuncture or give injections.
• Some states regulate who can practice radiography and administer medications.
• All states regulate lab procedures and protocols.
• Employers must understand regulations relevant to their employees.
• Employees have a professional responsibility to follow regulations.
• Practicing beyond one's scope can lead to legal consequences, including jail time.