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CPOE and ‘Any Licensed Health Care Provider’: Who Might that Be?

By Carol Bishop, associate director of practice economics and payer relations, Pennsylvania Medical SocietyPennsylvania Medical Society

With Stage 2 meaningful use (MU) reporting period around the corner, the Computerized Provider Order Entry (CPOE)  has put a lot of practices in a quandary—especially about medical assistants’ certification.

The final rule, dated Sept 4, 2012, from CMS clarifies that: “Any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines, can enter the order into CEHRT (certified electronic health record technology).  We finalize the more limited description of including credentialed medical assistants.  The credentialing would have to be obtained from an organization other than the employing organization.”

There was some question as to whether scribes would fall under the category of “any licensed health care professional.” However, CMS also clarified this by stating “We do not believe that a layperson is qualified to do this, as there is no licensing or credentialing of scribes, there is no guarantee of their qualifications.”

What about CPOE for laboratory and radiology orders?

The Stage 2 requirements for CPOE in 2014 have now added laboratory and radiology orders.

Computerized entry is required for 60 percent of medication orders, 30 percent of laboratory orders and 30 percent of radiology orders—excluding eligible providers who write fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period.

To ensure that you comply, you must evaluate your ordering workflow, including the use of CPOE.

What happens with my MU attestation that I’ve already submitted?

Many practices are concerned that they’re behind the eight ball already because they did not find out about the final rule (dated Sept. 4, 2012) until the beginning of 2014, as it went into effect Jan 1, 2013.

One of their most pressing questions is, what happens with the MU attestation that I’ve already submitted?  The answer: Relax.

For Stage 1 2013 CPOE criteria, the measure requires at least one medication order entered using CPOE for more than 30 percent of all unique patients with at least one medication in their medication list seen by the eligible provider. Eligible providers have more than likely met this measure on their own by using electronic prescribing.

Practices have a lot of decisions to make in short period of time.

The final rule has left many practices scrambling.  Are all our medical assistants credentialed?  How do we get them recredentialed?  Are our front office staff and referral scheduling staff eligible for any type of credential?  Our medical assistant did not graduate from an accredited program—what option is available for them?

What about credentialing for MAs, front office staff, and others?

Physicians depend on their clinical staff and certain front office staff to assist with laboratory and radiology orders under their delegation so that they, in turn, can see more patients in the course of a day.

For staff who did not graduate from an accredited MA program:

Let’s start with your practice’s front office staff, referral scheduling personnel, and medical assistants who did not graduate from an accredited medical assisting program. They can meet the CMS criteria to enter CPOE under the MU incentive program through the Assessment Based Recognition in Order Entry Program (ABR).

The ABR  is granted by the continuing education board of the American Association of Medical Assistants (AAMA) to applicants who meet eligibility criteria and submit required documentation and a completed application.  Those interested in pursuing the ABR will need to have knowledge in skill sets such as anatomy and physiology, basic laboratory values, critical thinking, electronic health records, HIPAA, medical terminology and pharmacology.  They must be employed for a minimum of 2-3 years in a health care facility and successfully complete five, one-hour CEU courses which consist of:

  • Clinical laboratory testing
  • Disease screening
  • Legal aspects of patient care documentation
  • Lost in translation: Eliminate medical errors
  • Medical records: A vital wave

Successful completion of this course does not provide the applicant with any type of certification and may not be used as a credential; no fancy suffixes can be appended behind the applicant’s name. It is simply an official recognition of the holder’s qualifications to enter CPOE into the EHR under CMS’s rules and is good for 24 months. For more information go to http://www.aama-ntl.org/continuing-education/abr-faqs.

For medical assistants who are graduates of an accredited school:

The medical assistants in your practice who have graduated from an accredited school and have never taken their test to become certified will need to furnish their original transcripts. The certifying board reserves the right to request a copy of the diploma, degree or certificate at any time. Find information about how to take the certification exam at http://www.aama-ntl.org/cma-aama-exam/faqs-certification.

The medical assistants in your practice who were previously certified but have let their certification lapse for more than 60 months must retake the certification test. Find more information at http://www.aama-ntl.org/continuing-education/faqs-recertification.

Hopefully, we’ve answered some of the top questions so that practices can meet CMS’s requirements to move forward in compliance with CPOE for Meaningful Use reporting.

For more information, contact the PAMED practice economics and payer relations division at (800) DOCHELP.

 

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