Understanding End Stage Renal Disease (ESRD) and Medicare

By Kea Nielsen | Director of Client Services and Compliance

Are you confused by the Medicare rules for End Stage Renal Disease (ESRD)? You are not alone. Many people struggle to understand how their health benefits can be affected, or how it can affect an employer’s self-funded health plan.

Understanding-kidney-failure-ESRD-MedicareESRD Medicare is complicated! When you bring in the Medicare Secondary Payer act, well, it can be downright mind numbing. As the director of client services and compliance, I hope to help clear out some of the cobwebs by offering helpful links for frequently asked questions and by answering your more complicated questions through legal research.

Did you know that members have several different options in which they can dialyze? It is possible that members can have a higher quality of life, while maintaining their work and existing lifestyle through home modalities. For more about home modalities, I recommend Home Dialysis Central, a non-profit organization that offers valuable information on treatment options.

Self-insured health plans can determine the coordination period of a member, depending on their modality choice, by using this Medicare calculator.

For members and patients with End-Stage Renal Disease, the barrier to understanding their benefits can be high, which is why we have an advocate such as myself to help you through the process. This easy-to-understand “Who Pays First”guide talks about how Medicare works with other kinds of coverage and whose responsibility medical bill payment is for dialysis.

Employers and members who would like more information can learn about what the Medicare Secondary Payerresponsibilities are, as it pertains to End Stage Renal Disease by reviewing this helpful guide about the coordination of benefits and recovery.

If you have questions about balance billing, cost containment, Medicare Part B or Medicare rules for End Stage Renal Disease, please contact me at knielsen@renalogic.com, or call 623-594-3117. Our team of Medicare and legal experts can help you understand the complex issues of primary and secondary payers and patient rights to Medicare Part B.

Note: End Stage Renal Disease is can also be known as renal failure or kidney failure.

Renalogic

Renalogic (formerly DCC, Inc.), headquartered in Phoenix, AZ, was founded in 2002 as a specialty dialysis cost-containment company to help clients understand the unique market dynamics in the dialysis provider community. The company has evolved to become a comprehensive provider of data-driven, end-to-end chronic kidney disease (CKD) care and cost management programs for the self-insured industry. Renalogic’s professional team includes leaders in healthcare administration, care management, legal specialists in ERISA and healthcare law, contract negotiation, payer/provider negotiation, and clinical experts.