IOP news & updates
June 7, 2021 | Issue 5
Legislative Corner

Ellis Consulting
Legislative Update, June 2021

The 2021 legislative session has finally ended, sort of. After the longest session in Idaho history, the senate did adjourn sine die, but the house only recessed, keeping open their opportunity to reconvene. Speaker Bedke said, “It is important to remember that no one is looking to create a full-time legislature, but we must make sure we can fulfill our
constitutional responsibilities should the unforeseen occur again.” Chief Deputy Kane from the Attorney General’s office commented, “the likely default result is that both chambers would be considered in recess.” If the house does not sine die if/when it returns, the Senate will likely have three days to return. A strange end to a very strange session.

While health care was not the primary focus of the legislative session, as in past years, there were several pieces of legislation of note.
  • HB 179 Interstate Telehealth: This legislation came out of a summer interim committee. It would have allowed any licensee in another state with a license in good standing to practice in Idaho without an Idaho license. This legislation had strong opposition from the provider community and was held in the House Health and Welfare Committee.
  • SB 1127 Telehealth Technologies: This legislation was brought by Tele-Doc and would have allowed telehealth via only audio or visual communication. This legislation did not have a hearing and was held in the Senate Health and Welfare Committee.
  • HB 38 Telehealth Prescribing: This legislation fixed what appeared to be an error in prior legislation that limited where patients could reside if receiving a prescription via telehealth. There was no opposition; the governor signed the legislation and will go into effect on July 1, 2021.
  • SB 1126 Virtual Care Act: This legislation came out of a Department of Health and Welfare Task Force and had much support from the provider community. After passing the Senate 30-5, it was held in the House Health and Welfare Committee.
  • SB 1024, 1026, and SB 1056 Division of Occupational and Professional Licensing Reorganization: All of these bills deal with the restructuring of the former Bureau of Occupational Licenses (IBOL) into the Division of Occupational and Professional Licensing (DOPL). They consolidate the boards under the new DOPL, centralize hiring for the boards, and merge board funds (although individual board monies will still be tracked. These bills each had an emergency clause and are now in effect.
  • SB 1084 Sunset Review: This legislation requires all boards to go through a sunset review process every 5 years. Statutorily a committee is to be appointed to review the pros and cons of licensure.

After a long and sometimes trying session, legislators are ready to get back home to their families. It was eerily quiet early in the session with limited access to the Capitol. However, as legislators have received the vaccine, it opened up, and I expect next year will be close to back to normal.

It has been a pleasure to serve the association this session.

Sincerely,
Kris Ellis
Ellis Consulting
Legislative Committee

Rewrite of our Optometric Act Update: Spring 2021
 
What’s happening right now?
Since our legislative loss in early 2020, the IOP Legislative Committee has been looking at the next steps we want to take with the update of our Optometric Act. We have already met with the Executive Director and the Regulatory Affairs Manager for the Idaho Division of Occupational and Professional Licenses (DOPL). They are most interested in updating the statute and allowing optometrists to practice to the extent of their training in the least restrictive manner. Once the legislature adjourns, we will be following up with them to develop the next steps. 
 
Okay, all of that is great, but what do you want/need from me?
We still need Key People for many of our legislators. Currently, 43% of our legislators are without an assigned key person - an optometrist that they can talk to about any eye-related legislation that comes across their desk. 
 
What if I don’t know or have relationships with any of the legislators in my district?
That’s what being a key person is all about. Even if you don’t have a relationship yet, it’s about establishing one with a legislator to get to know them and for them to get to know you, so you have a connection you can build on when it comes time for optometric legislation. 
 
How do I even begin to start a relationship with a legislator?
It’s easier than you think. Just start by sending them an email introducing yourself. We have a template that you can use on our KP dashboard. Next, follow them on social media, sign up for their email newsletters - these things show them you’re engaged with their legislative process. Finally, when the session is over, invite them to your office or out for coffee to find out what they know and don't know about optometry and educate them on everything we can do outside of glasses and contact lenses. Share a story of how you helped a patient beyond correcting their vision; if you can include a donation to the legislator at this meeting, even better. 
 
You mentioned something about a KP dashboard…
Yes! The KP (Key Person) Dashboard is a program that the IOP has invested in that allows us to keep track of what has been done with each legislator and important information about each one so that no one slips through the cracks. This dashboard program includes an in-depth how-to guide at the tip of your fingers: what to say in your first email, personal and professional details about your legislator, where and how to contact them, etc. It also includes a place for you to put notes/updates directly to the legislative committee to keep us in the loop of how things are going. The program then collects all the information our key people obtain from each legislator and compiles it so that we can see how favorable legislation may be moving forward or what action needs to be taken. 
 
How do I get access to the KP dashboard? I have too many passwords to remember already… 
That’s another awesome part of the dashboard. All you have to do is go to: https://app.kpdashboard.com/login and enter your cell phone number or email address. As long as we have one of those on file, that’s all you need to log in. If you are unable to log in that way (1) please update the IOP with your correct contact information and (2) ask your regional director for a link or our Executive Director Lisa at execdir@iopinc.org - the link sent to you will be good for 2 hours after it has been opened. 
 
When does this all start?
Well, now. We don’t know yet if we’ll be moving forward with legislation in 2021-22 or 2022-23, but we need to start strengthening our grassroots now for moving forward in either session. We are asking all key people to please get to the point where you’re inviting your legislator to an in-person meeting over the summer. Then record your progress on the dashboard and let us know how it went! Please let us know if you need any information or guidance on any of the steps towards strengthening your key person relationships. 
 
Finally, thank you SO MUCH to the optometrists who already have and are maintaining a relationship with their legislators already. We would not be able to even attempt to do anything legislatively if it wasn’t for you and your efforts!

Lauren Huber, OD
IOP Legislative Chair 
Membership Committee

Welcome to the IOP to Drs. Brian McNeel, Vanessa Ewing, Rebecca Jangula, Scott Kawakami, and Chad Schobert!

Also, look for text messages regarding legislative updates and other IOP news!

Please contact Dr. Doug Adams with any membership questions at iopmemcomm@gmail.com.
IMPAC - Informal Medicare Professional Advisory Council
Dear Colleagues,

At the most recent IMPAC meeting, there was nothing discussed that was important to optometry. I recently have been hearing from other colleagues how Medicare is not reimbursing for certain codes. This was not discussed at the last IMPAC meeting, but I hope to have more information about any changes as I hear more about this issue. If there are any policy change updates at my next meeting, I will report to you about it in my next column. As we are opening up more after the pandemic, I hope all of your practices are doing well.

Sincerely,
Gideon Bender, OD
Third Party Center

UnitedHealthcare to Pay Separately for Refraction
As AOA has long advocated for vision plans, UnitedHealthcare/Spectera will reimburse separately for the eye examination and refraction beginning May 1, 2021. If you are a Spectera provider, you should have received an addendum to your contract for review explaining the updates. AOA always recommends that doctors carefully review contracts and contract amendments to understand your rights and obligations before making an independent business decision about what you are willing to agree to.

Claw Backs
Some vision plans are known to “claw back” payments from claims by recouping the funds from current claims. Many of these claims had been submitted a number of years in the past and were often correctly billed. The AOA believes this violates many states’ insurance claim recoupment laws, which set limits on how long an insurer has to recoup money from overpaid claims (often 18 months or less). The AOA began collecting examples of these clawbacks in 2020, right before the start of the COVID-19 pandemic and will pick up this advocacy objective again in 2021. The AOA seeks to question this poor business practice, in coordination with state affiliates, in the states where these
plans are most blatantly violating insurance recoupment laws. If you have experienced a clawback from a vision plan for a years-old claim, please provide documentation (redacted to protect any confidential patient information) to the AOA’s Third Party Center at stopplanabuses@aoa.org.

As always, feel free to reach out if you have any questions about insurance or billing.

Enjoy Summer!!!
Terri L. Haley, O.D.
IOP Third Party Chair
Is this a 90004/90014 or a 90002/90012?

Optometrists are asking, “Are glasses and contacts considered a form of treatment to qualify for a 92004/92012 examination?”

Some of Idaho’s optometrists have received a Comparative Billing Report from the Centers for Medicare & Medicaid Services describing an individual’s billing habits relative to their peers. Medicare and Medicaid Services are concerned that the ratio of 90004/ 92014 versus 92002/ 92012 is not within their expectation and that some of us may be overutilizing the comprehensive examination code. It is my belief that the CBR is flawed by not taking into account that optometrists may choose to use either a 99xxx code or an eye code in determining which level of service to bill. As long you are following the 2021 CPT guidelines and that your record clearly documents your findings and rationale; regardless of the CBR, you should be able to survive an audit. Reviewing the AMA 2021 CPT:

Comprehensive ophthalmological service describes. A general evaluation of the complete visual system. The comprehensive service constitutes a single service entity but need not be performed at one session. The service includes history, general medical observation, external and ophthalmological examination, gross visual fields, and basic sensorimotor examination. It often includes, as indicated: biomicroscopy, examination with cycloplegia or mydriasis, and tonometry. It always includes initiation of diagnostic and treatment programs.

Initiation of diagnostic and treatment program includes the prescription of medication, and arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures, and radiological services.

Do I perform all the services needed to qualify for a comprehensive examination driven by the patient’s chief complaint? Absolutely, but I certainly do not order an x-ray, a lab test, refer for a consult, order a visual field or order an MRI on every 92004/9014 examination; sometimes the patient just needs a new eyeglass prescription. Many of us that attended the IOP congress last year may have remembered Dr. John McGreal, coding expert, discussing the new coding changes and that glasses and contacts may not be considered a form of treatment. A billing specialist in the audience proclaimed that our Medicare carrier, Noridian, Jurisdiction F, did in fact allow glasses and contacts as a form of treatment. To which, Dr. McGreal replied, every region was unique. So, after several calls to Noridian, CMS, and a congressional inquiry, here is the answer.

In the definition of a treatment program, glasses or contact lenses is not explicitly applied; however, the term “special ophthalmological services” is, and is defined as:

Special ophthalmological services describe services in which a special evaluation of part of the visual system is made, which goes beyond the services included under general ophthalmological services, or in which special treatment is given. Special ophthalmological services may be reported in addition to the general ophthalmological service or evaluation and management services.

Although not specifically stated, but indirectly construed by representatives of CMS Medicare via reference articles provide by Noridian such as https://www.aao.org/eyenet/article/fact-sheet-for-the-comprehensive-eye-visit-codes a refraction 92015 is a special ophthalmological service. Therefore, it is the act of the refraction, not the prescription for lenses, which allows optometrists to treat with glasses

or contact lenses and qualify a 92004/92014 code. Unfortunately, if a diabetic is in your office because their primary physician wants a screening for retinopathy; if that patient has 20/20 habitual acuity, no visual complaints, or discovered medical concern, then that patient may only qualify for a 92002/92012 code.

For more information:

The Medicare Administrative Beneficiary and Provider Communications Manual, Chapter 6, Section 30.3.1, found at https://www.cms.gov/Regulationsand Guidance/Guidance/Manuals/Downloads/com109c06.pdf, explains the following: “Providers are responsible for determining the correct diagnostic and procedural coding for the services they furnish to Medicare beneficiaries. Customer Service Representatives (CSRs) shall not make determinations about the proper use of codes for the provider. When providers inquire about the interpretation of procedural and diagnostic coding, they shall be referred to the entities responsible for those coding sets. CSRs shall refer providers with questions about coding to the following information sources, as appropriate:

1. Current Procedural Terminology (CPT) codes are proprietary to the American Medical Association (AMA). As such, CPT coding questions from providers shall be referred to the AMA. The AMA offers CPT Information Services (CPTIS). This Internet-based service is a benefit to AMA members and is available as a subscription fee-based service for non-members and non-physicians. The AMA also offers CPT Assistant. Information about these resources is found at https://www.ama-assn.org/.

2. The American Hospital Association (AHA) has a website with many resources for answers to coding questions. Information is available at http://www.ahacentraloffice.org/ The website also has a direct link to the AHA Coding Clinic http://www.codingclinicadvisor.com/ whereby coding questions may be submitted and tracked.

3. Level II Healthcare Common Procedure Coding System (HCPCS) codes related to durable medical equipment or prosthetics, orthotics, and supplies are answered by the Pricing, Data Analysis and Coding (PDAC) Contractor. Information about the PDAC Contractor and the services it provides can be found at https://www.dmepdac.com/.

Submitted by Dr. Rod White
Paraoptometric Committee

Greetings, Doctors, and Paras!

We are under 150 days from Congress! Early registration savings end on June 30th! Take advantage of more savings when booking your rooms at the Coeur d’Alene Resort by mentioning you are attending - limited space, so reserve early! 

Classes will start on Thursday, October 14th at 1:00 PM - flights into Spokane are available that morning if you’re coming from out of town. Take advantage of more savings when booking your rooms at the Coeur d’Alene Resort by mentioning you are attending - limited space, so reserve early! Classes will continue all day on Friday the 15th - no classes on Saturday for Paras!

Our speakers include Sharon Carter, ABO, NCLE, Kayla Ashlee, ABO with Spexy, and Dr. Scott Lewis, OD. I think we have a good variety of classes to offer everyone in your office! Classes can be viewed with a description here - the para schedule is near the end. 

If you have any questions, shoot me an email at iop.cc.para@gmail.com

See you in October!

Tami Arnett, CPOA, ABOC
IOPPS Committee Chair