Wednesday, June 30, 2004

PSA wins $500,000 Medicare audit appeal

NORCROSS, Ga. - A Medicare audit appeal ruled in favor of Pediatric Services of America in May. The decision, which had been pending since November 2002, could result in a reimbursement of $500,000 of the $800,000 Medicare had recouped from the company in 2003. Medicare had said that PSA claims included incomplete clinical documentation to substantiate payment and had recouped $800,000 from PSA. The Medicare Appeals Council has until mid-July to review the administrative law judge’s decision. PSA provides pediatric home health care, including nursing services and HME.
Study links diabetes to Alzheimer’s disease

YARMOUTH, Maine - Diabetics are 65% more likely to get Alzheimer’s disease, according to a study published by the American Medical Association’s Archives of Neurology that points to a strong connection between the two ailments. The study followed 824 Catholic nuns, priests and brothers age 55 and older and used a battery of mental tests not only to diagnose Alzheimer’s but also to see which cognitive functions were affected the most by diabetes. The Alzheimer’s Association said the new research is one of the first long-term studies to follow people with no signs of Alzheimer’s and track how diabetes affects their risk of getting the neurological disorder.
Three providers sign on to Medicare DSM trial

WASHINGTON - CMS has begun its four state Disease Management Demonstration for chronically ill patients with diabetes and advanced stage heart disease. Up to 30,000 Medicare fee-for-service patients will participate in the three-year trial. Four providers started enrolling beneficiaries in the program in May. CorSolutions in Louisiana will provide services to 5,000 heart failure and diabetes patients. XL Health in Texas will treat 10,000 beneficiaries for diabetes and congestive heart failure, and HeartPartners in California and Arizona will provide services to 15,000 congestive heart failure patients. CMS hopes to determine the benefits of DSM through this trial and to find ways to improve the quality of life for chronically ill patients.