Section 1: Introduction A. Welcome to Medicare for People With End-Stage Renal Disease (ESRD), presented by Relias Learning! This lesson explains Medicare for People With End-Stage Renal Disease. It includes information on eligibility and enrollment, coverage, health plan options, and provides additional sources of information. B. Meet Tom C. Learning Objectives After taking this course, you will be able to: a. Define ESRD b. Explain Medicare eligibility and enrollment rules c. Determine what’s covered under Medicare d. Identify health plan options for people with ESRD Section 2: Overview of Medicare for People With ESRD A. ESRD Basics B. Eligibility for Medicare Part A (Hospital Insurance) Based on ESRD C. Medicare Part B (Medical Insurance) Eligibility D. Review E. Summary Section 3: Medicare Enrollment Based on ESRD F. Enrolling in Medicare Part B G. Delaying Medicare Part B H. How to Enroll in Part A and Part B I. Medicare and Group Health Plan (GHP) Coverage (30-Month Coordination Period) J. Enrollment Considerations—30-Month Coordination Period K. Enrollment Considerations—Immunosuppressive Drugs L. When Medicare Coverage Starts Based on ESRD M. When Coverage for ESRD Ends, Continues, or Resumes N. Review O. Summary Section 4: What Medicare Covers A. What Medicare Covers for People With ESRD B. Covered Dialysis Services C. Home Dialysis D. Home Dialysis Training E. Home Dialysis Services NOT Covered Under Part B F. Ambulance Transportation G. Part A Transplant Patient Coverage H. Medicare Part B Transplant Patient Coverage I. Review J. Summary Section 5: Coverage Options for People With ESRD K. ESRD and Medigap Policies L. ESRD and Medicare Advantage (MA) Plans M. ESRD and Medicare Advantage (MA) Plans Continued N. Special Needs Plans (SNPs) O. ESRD and Medicare Prescription Drug Coverage P. Medicare and the Health Insurance Marketplace Q. ESRD and State High-Risk Pools R. Review S. Summary Section 6: Additional Sources of Information T. Dialysis Facility Compare Star Ratings U. ESRD Networks V. Fistula First Catheter Last W. Summary Section 7: Conclusion A. Key Points to Remember B. Summary C. Course Contributors D. Resources E. References F. Acronyms G. Congratulations H. Exam I. Brain Sparks
Lisa Hohlbein, RN, CDP brings over 25 years of healthcare experience and offers cutting-edge expertise in the areas of the RAI process and clinical reimbursement systems. Her experience includes performing and overseeing various reimbursement reviews for Medicaid and PPS in multi-state, skilled nursing facilities, long-term care, and sub-acute care assessment and operations. Lisa has presented workshops on a variety of topics at the facility, regional, state, national, and international (Canada) levels. She was a Master Teacher with AANAC, participated on their Expert Advisory Panel, and has presented at their annual conferences. Lisa has also been a contributor to MDS Alert, Provider Magazine, LT Living, and AANAC's LTC Leader. Lisa is also a Certified INTERACT Educator, Certified Dementia Care Practitioner, and was previously a Certified Alzheimer's Disease and Dementia Care Trainer. Disclosure: Lisa Hohlbein, RN, CDP has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.Staff Writer: Adam Roesner, BSN
Adam Roesner, BSN has been working with various quality measures optimization since 2013. His experience in program management in both clinical and performance measures allows a unique perspective on the challenge faced by healthcare systems today. Adam has presented trainings on HCAHPS programs for sales forces and executive leadership alike, and has managed various skin health and HCAHPS educational programs and bundles for acute, post-acute, and IDN facilities. Disclosure: Adam Roesner, BSN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.