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“Assessment-Based Recognition in Order Entry: Why the AAMA Created the Program” by Donald Balasa, JD, MBA

Verify ABR-OE Status

“The AAMA Launches Order Entry Competence Outreach to Payers” by Donald Balasa, JD, MBA

CMAs (AAMA)® do not need the ABR-OE. The CMA (AAMA) credential meets the CMS “credentialed medical assistant” ​definition because CMA (AAMA) education, training, and testing includes electronic order entry. Therefore, the ABR-OE is not granted to CMAs (AAMA).

Those who are students in a CAAHEP- or ABHES-accredited medical assisting program at any point in time are not eligible to participate in the ABR-OE program. Also, those who at any point in time have held the CMA (AAMA) credential (or its predecessor credential, CMA) are not eligible for the ABR-OE.

FAQs on Assessment-Based Recognition in Order Entry (ABR-OE)

The Centers for Medicare & Medicaid (CMS) meaningful use order entry requirements for the Medicaid Promoting Interoperability Program will end December 31, 2021. (The order entry requirements for the Medicare Promoting Interoperability Program ended January 1, 2019.)

For providers to receive incentive payments under the Medicaid Promoting Interoperability Program, providers had to demonstrate that a certain percentage of medication, laboratory, and diagnostic imaging orders were entered into the computerized provider order entry (CPOE) system by either (1) credentialed medical assistants or (2) licensed health care professionals. 

Here are answers to the most frequently asked questions about the ABR-OE program.

Not at all. The AAMA remains firmly committed to proving, advocating for, and defending the fact that the CMA (AAMA)® is the premier credential for medical assistants. There has been no change in the AAMA's position that the CMA (AAMA) remains the superior and unmatched way of demonstrating knowledge of, and competency in, all facets of the medical assisting profession, through meeting these main requirements:

  • Graduating from a college-level academic medical assisting program accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES)
  • Passing the CMA (AAMA) Certification Exam
  • Maintaining currency of the CMA (AAMA) credential by recertifying

Starting January 1, 2013, only "credentialed medical assistants" (in addition to licensed health professionals) were permitted to enter medication, radiology, and laboratory orders into the electronic health record (EHR) and have such entry count toward meeting the meaningful use thresholds under the Medicare and Medicaid EHR Incentive Programs (which were later renamed to the Medicare and Medicaid Promoting Interoperability Programs).

(Note: The order entry requirements for the Medicare Promoting Interoperability Program ended January 1, 2019.)

Working medical assistants who have not graduated from a CAAHEP- or ABHES-accredited medical assisting program are not eligible for the CMA (AAMA)® Certification Exam, and therefore have no way of meeting the CMS requirement through the AAMA. Consequently, as the leaders of the medical assisting profession and the AAMA, the Board of Trustees realized it was incumbent on them to provide a way for these non-CAAHEP or ABHES medical assistants to demonstrate knowledge of electronic order entry and meet the CMS requirement. The BOT concluded that the best way to assist these medical assistants would be by awarding an assessment-based recognition to those who meet certain knowledge and experience requirements and complete four AAMA continuing education courses covering key knowledge elements of electronic order entry.

Protection of patients and providers

Continuing education offerings must meet strict standards in order to be awarded AAMA continuing education units (CEUs) by the Continuing Education Board. By requiring successful completion (including receiving a passing score on the post-tests) of four online AAMA CEU courses in areas essential for accurate and efficient electronic order entry, the AAMA will help ensure that patients will have their EHRs handled appropriately. In addition, physicians and other eligible providers will receive a measure of assurance that their orders will be understood and appropriately transmitted.

Support of CMS and an important health initiative

Despite the ongoing controversies over the Affordable Care Act, most health policy analysts—regardless of political or ideological leanings—believe that transitioning American health records to an electronic system will reduce medical errors and will improve the well-being of all Americans. Providing an assessment-based recognition program in EHR order entry will show that the AAMA is concerned about the quality and effectiveness of the American health care system as a whole, and is willing to support the United States Department of Health and Human Services (DHHS) and CMS in the Promoting Interoperability Programs (previously called the "EHR Incentive Programs"). Also, offering this ABR-OE is a logical follow-up to the joint presentation given by Robert Anthony, deputy director of the Health Information Technology Initiatives Group of CMS, and me to the AAMA House of Delegates at the 57th Annual Conference in September 2013.

Solidifying the role of the AAMA as the recognized voice of medical assisting

Deputy Director Anthony's presentation spoke volumes about the high opinion that CMS has of the AAMA. Responding to an immediate need for a narrowly targeted assessment-based recognition program in EHR order entry demonstrates that the AAMA can respond in a timely manner to the ever-changing dynamics of the allied health labor market. The AAMA will maintain the integrity of its CMA (AAMA)® program by not diluting its eligibility requirements while providing a narrowly niched ABR-OE in response to an urgent (but perhaps temporary) market need. These efforts demonstrate beyond question that the AAMA has both the foresight and the resources to lead the medical assisting profession throughout the 21st century.

The following excerpt is from an Institute for Credentialing Excellence (ICE) publication Defining Features of Quality Certification and Assessment-Based Certificate Programs:


The primary focus of a professional/personnel certification program is on providing an independent assessment of the knowledge, skills, and/or competencies required for competent performance of an occupational or professional role or specific work-related tasks and responsibilities.

Certification also is intended to measure or enhance continued competence through recertification or renewal requirements.

The certification awarded designates that participants have demonstrated the requisite, work-related knowledge, skills, or competencies and met other requirements established by the certification program provider (e.g., academic degree, specific number of years of occupational or professional experience).

Assessment-based certificate program

The primary focus of an assessment-based certificate program is on facilitating the accomplishment of intended learning outcomes. Although assessment is an integral part of the certificate program, the primary purpose of the program is to provide education and training which supports the accomplishment of the intended learning outcomes.

The certificate awarded designates that participants have completed the required education/training and demonstrated accomplishment of the intended learning outcomes.

The AAMA decided to call its assessment-based program a recognition program rather than a certificate program to more clearly distinguish the ABR-OE from the CMA (AAMA)® certification program.

The ABR-OE is operational as of January 2, 2014.

No. Allowing the use of an initialism could be misleading. Holders of this ABR-OE can refer to themselves as having an assessment-based recognition in electronic order entry but are not permitted to use any suffixes or initials after their names in reference to this recognition program.

No. Those who are students in a CAAHEP- or ABHES​-accredited medical assisting program at any point in time are not eligible to participate in the ABR-OE program. Also, those who at any point in time have held the CMA (AAMA) credential (or its predecessor credential, CMA) are not eligible for the ABR-OE.

As indicated above, the AAMA remains resolute in its position that graduating from a CAAHEP- or ABHES-accredited medical assisting program and earning and maintaining CMA (AAMA)® certification are all essential for protecting patients, health care providers, and medical assistants themselves from substandard medical assisting services. Graduation from a CAAHEP- or ABHES​-accredited medical assisting program and obtainment of another credential are not sufficient to provide assurance of acceptable medical assisting competence and knowledge. Given these realities, the AAMA Board of Trustees decided that the unique competence and knowledge resulting from completion of a CAAHEP- or ABHES​-accredited program and achievement of CMA (AAMA) certification would be blurred by giving CAAHEP and ABHES graduates the option of obtaining the ABR-OE.

An applicant must submit proof of having been employed for a minimum of 24 months during the last 36 months in a health care facility under the supervision of a licensed health care professional.

An applicant must submit a statement, signed by the applicant's current licensed health care supervisor, attesting that the applicant is proficient in EHR order entry as demonstrated by the applicant's knowledge in the following areas:
  • Anatomy and physiology
  • Basic laboratory values
  • Critical thinking
  • Electronic health records
  • Health Information Portability and Accountability Act (HIPAA)
  • Medical terminology
  • Pharmacology
An applicant must successfully complete (including receiving a passing score on the post-tests) the AAMA continuing education unit (CEU) courses listed under “Assessment-Based Recognition in Order Entry Qualifying Courses” in the e-Learning Center.

The following policies apply to all renewals:

  • Renewing ABR-OE holders will not be required to submit a verification letter from their employers.
  • Renewing ABR-OE holders who have let their recognition lapse will be required to pay an additional $50 fee to renew.
  • The date of the renewal is 24 months from the date of the initial recognition or the most recent renewal. If the ABR-OE holder chooses to renew early, the next renewal date will be 24 months from that early date. Renewing ABR-OE holders may renew up to 90 days prior to their expiration date.
  • No refunds will be allowed for new applications and renewals.

Call the AAMA Continuing Education Department at 800/228-2262.

Questions? Contact Donald A. Balasa, JD, MBA, at or 800/228-2262.