St. Luke's Draw Denials

St. Luke's Meridian recently denied an order for a serum tear draw as it was written by an OD and not an MD, DO, NP, or PA. I contacted St. Luke's several weeks ago asking for clarification and received the following response today...

Thank you for your patience and cooperation during this review process. As we continue to review the ordering eligibility policy, Dr. Hill has indicated that we can still collect serum tears ordered by optometrists. I will send out communication to the phlebotomy staff today to reinforce this. While the system policy is still being finalized, there may be some uncertainty on the part of the collectors, but we are working to address it. If you encounter any patient rejections, please contact me directly so I can follow up with the site supervisor promptly. Thank you for your continued support and understanding.

In the meantime, if you have any issues with St. Luke's please let me know. Any updates from St. Luke's will be included in the December newsletter.

OCT Modifiers

If claims for codes 92133 and 92134 have been denied, they do require RT

and LT modifiers.

The program manager at Medicaid sent the following.

We were recently alerted during an audit that claims were not processing correctly for these modifiers. A patch was implemented to the claims processing system to correct codes we were immediately alerted to. We are still reviewing and working on implementing a more comprehensive list.

If the provider has claims denied or recouped for lack of a modifier, they should be able to adjust them to add the modifier and reprocess them for payment. If the provider is beyond the timely filing limit for adjustments, they can follow the Claim Review Request and Appeals process. I will approve them for payment if they include me in the request.

The best pathway for communication on issues for individual providers would be to contact their provider relations consultant (PRC) at Gainwell. If the PRC is unable to assist them, they will refer them to my team. Organizations looking for assistance can contact the policy team directly at MCPT@dhw.idaho.gov.

Parental Consent

Required

SB 1329 - Effective July 1, 2024, Idaho healthcare providers must obtain parental consent to treat unemancipated minors or face civil liability except in emergency cases. 

We have initiated a conversation with Representative Skaug to amend SB 1329. DOPL is working to provide amendment language and a blanket consent form. We will provide more information as it becomes available.

Click here to read the bill.

FTC Eyeglass Rule

The Eyeglass Rule requires optometrists to provide patients with their prescription immediately after an eye exam. This can be sent electronically. The FTC is publishing a final rule to implement amendments to the Eyeglass Rule requiring prescribers to obtain a signed confirmation after releasing an eyeglass prescription to a patient and maintain each confirmation for at least three years.

These changes took effect on 9/24/24.

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Please get in touch with Kara Webb, KCWebb@aoa.org, if you have any questions.