The Executive Suite: What duties can medical assistants take on? Some principles for delegating

A number of resources exist for physicians to research whether they can delegate some practice duties to medical assistants (MAs).

In just the last year, there has been a current of change in the laws governing delegation and duties for medical assistants, said Donald A. Balasa, JD, MBA, CEO and legal counsel of the American Association of Medical Assistants (AAMA).

There also are a lot of laws to keep track of, he said during the presentation “How Recent Changes in State and Federal Medical Assisting Law Can Increase Revenue and Decrease Cost.” Balasa was a presenter in the 2022 Medical Practice Excellence Leaders Conference of the Medical Group Management Assocation.

He outlined a number of recent changes to MA duties in various states and some definitions and general guidelines for integrating MAs into practices. Changes are coming quickly and more may be in the works.

In Connecticut, starting this month, MAs may administer vaccinations. In South Carolina, starting in July, MAs may administer certain medications by certain routes under supervision of physicians, advanced practice registered nurses, and physician assistants. In March, Utah allowed physicians to exercise “general supervision” over MAs, meaning supervision by direct face-to-face contact or direct voice contact by telephone, radio, or another means.

And there have been other legal changes in states such as Washington, Colorado, and Delaware.

It’s the law

The Code of Federal Regulations defines services and supplies incident to a physician’s services. The services and supplies incident to a physician’s professional service are reimbursable under that rule if the service or supply is furnished as an incidental, although integral, part of a physician’s professional services.

That rule now goes beyond traditional doctors of allopathic and osteopathic medicine. It now includes nurse practitioners and physician assistants as providers, Balasa said.

The federal law determines reimbursement for services of medical assistants under the Medicare and Medicaid programs. State law generally governs scope of practice for medical assistants.

General principles

When considering delegating duties to medical assistants, physicians should know:

Some state laws are general, while others are specific, in covering what tasks medical assistants may perform. In fact, the phrase “medical assistant” may not appear in state laws, leaving statutes open to interpretation, Balasa said.

Here are some points to keep in mind:

There is a litmus test to consider MA duties: Is the task customarily designated to MAs in your area of the state?
Consider the curriculum for MAs in local programs and if the task is taught, that bolsters the argument that a task is delegable to an MA.
It is not permissible for MAs to perform tasks that constitute the practice of medicine or require the skill and knowledge of physicians or other licensed providers. Balasa noted physicians or administrators may believe if a physician thinks the MA is competent at a task, then the task may be delegated, but that is not correct legally. If the task requires the skill and knowledge of a licensed provider, it cannot be delegated to an MA.
MAs may not perform tasks that are restricted in state law to other health professionals, including licensed professionals such as physical therapists or acupuncturists. For example, health care leaders may think that by teaching physical therapy exercises to an MA, they do not have to hire a licensed physical therapist, but that is not legally correct, Balasa said.
MAs may not perform tasks that require clinical assessments, evaluations, or interpretations.
Generally, MAs must not be delegated and must not perform any tasks for which they are not sufficiently knowledgeable and competent.
If there is a question, physicians can ask medical malpractice insurance carriers for a written opinion about tasks that may be delegated and would be covered in the case of negligence.

More information

The AAMA website has a number of additional resources, including a list of “State Scope of Practice Laws.” Balasa is the author of the AAMA’s Legal Eye: On Medical Assisting blog, and an archive of public affairs articles is available from 2005 to the present.