J11 Part A Medicare Secondary Payer (MSP ... - Palmetto GBA

End-Stage Renal Disease(ESRD)Example:• Beneficiary diagnosed with ESRD and begins dialysis on1/1/2009 Medicare entitlement begins 4/1/2009(Remember: Entitlement begins once a 3 month waiting period afterbeginning dialysis is completed) Medicare is secondary beginning 4/1/2009(Remember: Medicare is secondary for 30 months after entitlement begins)• Beneficiary enrolls in Self-Dialysis Training on 1/15/2009 Therefore, Medicare entitlement begins 1/1/2009(Remember: Entitlement begins at the beginning of the month a beneficiaryenrolls in Self-Dialysis Training)March 201122End-Stage Renal Disease(ESRD)Medicare coverage ends:• 12 months after the month the individual nolonger requires maintenance dialysis; or• 36 months after a successful kidney transplant.March 201123Special ESRD SituationsMarch 2011Dual Entitlement: Beneficiary is entitled toMedicare based on ESRD and also on the basis ofage or disability at the same time.• ESRD law applies regardless of the age of the Medicarebeneficiary.When a beneficiary becomes entitled on the basis ofage or disability after being entitled based on ESRD,the coordination period continues for the remainderof the 30 months.As long as dual eligibility/entitlement exists, theESRD MSP provision applies exclusively.248