Protoemics diabetes test gets important US health insurance nod
PromarkerD has just been assigned an American Medical Association PLA billing code, required for doctors to order the test and for facilities to bill for its use. From October 1, patients and healthcare providers will be able to submit claims for the test to be reimbursed by their health insurers – an essential step towards a broader market uptake.
PromarkerD was designed to meet an area of unmet need by identifying diabetic patients at risk of developing kidney disease four years before any symptoms appear.
According to the company's latest clinical study, its patented next-generation PromarkerD test accurately predicted kidney function decline in up to 86 per cent of patients who otherwise showed no symptoms, replicating the results from earlier clinical trials.
'Ensuring kidney health is a priority for our company and obtaining this dedicated PLA code is a crucial milestone in our strategy to improve access to meaningful diagnostic tests.'
Proteomics International managing director Dr Richard Lipscombe
Catching early signs of diabetic kidney disease means patients can receive preventive care well before they develop costly and life-threatening end-stage kidney disease, avoiding the need for dialysis or a kidney transplant.
The simple finger-prick blood test could potentially throw a lifeline to more than 32 million Americans living with type 2 diabetes, given more than half of all adults with diabetes in the US will develop kidney complications. These cases contribute to a colossal US$130 billion in annual healthcare costs - more than a quarter of the nation's Medicare budget.
Proteomics International managing director Dr Richard Lipscombe said: 'Ensuring kidney health is a priority for our company and obtaining this dedicated PLA code is a crucial milestone in our strategy to improve access to meaningful diagnostic tests. Expanding access to PromarkerD will help to improve kidney health for patients everywhere.'
The PLA code is widely used across America's complex health insurance system to report the use of medical procedures and services. It also allows insurers to monitor their use.
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The Age
8 hours ago
- The Age
Protoemics diabetes test gets important US health insurance nod
Proteomics International is on the verge of releasing its groundbreaking PromarkerD diabetes-related blood test across the United States, a milestone step ahead the device's international commercialisation. PromarkerD has just been assigned an American Medical Association PLA billing code, required for doctors to order the test and for facilities to bill for its use. From October 1, patients and healthcare providers will be able to submit claims for the test to be reimbursed by their health insurers – an essential step towards a broader market uptake. PromarkerD was designed to meet an area of unmet need by identifying diabetic patients at risk of developing kidney disease four years before any symptoms appear. According to the company's latest clinical study, its patented next-generation PromarkerD test accurately predicted kidney function decline in up to 86 per cent of patients who otherwise showed no symptoms, replicating the results from earlier clinical trials. 'Ensuring kidney health is a priority for our company and obtaining this dedicated PLA code is a crucial milestone in our strategy to improve access to meaningful diagnostic tests.' Proteomics International managing director Dr Richard Lipscombe Catching early signs of diabetic kidney disease means patients can receive preventive care well before they develop costly and life-threatening end-stage kidney disease, avoiding the need for dialysis or a kidney transplant. The simple finger-prick blood test could potentially throw a lifeline to more than 32 million Americans living with type 2 diabetes, given more than half of all adults with diabetes in the US will develop kidney complications. These cases contribute to a colossal US$130 billion in annual healthcare costs - more than a quarter of the nation's Medicare budget. Proteomics International managing director Dr Richard Lipscombe said: 'Ensuring kidney health is a priority for our company and obtaining this dedicated PLA code is a crucial milestone in our strategy to improve access to meaningful diagnostic tests. Expanding access to PromarkerD will help to improve kidney health for patients everywhere.' The PLA code is widely used across America's complex health insurance system to report the use of medical procedures and services. It also allows insurers to monitor their use.
Sydney Morning Herald
8 hours ago
- Sydney Morning Herald
Protoemics diabetes test gets important US health insurance nod
Proteomics International is on the verge of releasing its groundbreaking PromarkerD diabetes-related blood test across the United States, a milestone step ahead the device's international commercialisation. PromarkerD has just been assigned an American Medical Association PLA billing code, required for doctors to order the test and for facilities to bill for its use. From October 1, patients and healthcare providers will be able to submit claims for the test to be reimbursed by their health insurers – an essential step towards a broader market uptake. PromarkerD was designed to meet an area of unmet need by identifying diabetic patients at risk of developing kidney disease four years before any symptoms appear. According to the company's latest clinical study, its patented next-generation PromarkerD test accurately predicted kidney function decline in up to 86 per cent of patients who otherwise showed no symptoms, replicating the results from earlier clinical trials. 'Ensuring kidney health is a priority for our company and obtaining this dedicated PLA code is a crucial milestone in our strategy to improve access to meaningful diagnostic tests.' Proteomics International managing director Dr Richard Lipscombe Catching early signs of diabetic kidney disease means patients can receive preventive care well before they develop costly and life-threatening end-stage kidney disease, avoiding the need for dialysis or a kidney transplant. The simple finger-prick blood test could potentially throw a lifeline to more than 32 million Americans living with type 2 diabetes, given more than half of all adults with diabetes in the US will develop kidney complications. These cases contribute to a colossal US$130 billion in annual healthcare costs - more than a quarter of the nation's Medicare budget. Proteomics International managing director Dr Richard Lipscombe said: 'Ensuring kidney health is a priority for our company and obtaining this dedicated PLA code is a crucial milestone in our strategy to improve access to meaningful diagnostic tests. Expanding access to PromarkerD will help to improve kidney health for patients everywhere.' The PLA code is widely used across America's complex health insurance system to report the use of medical procedures and services. It also allows insurers to monitor their use.
The Advertiser
a day ago
- The Advertiser
Doctors dispute billions being lost in Medicare fraud
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment.
