COB Playbook

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 Playbook User Key  Important Information about Playbook  Three Themes  All About Insurance /Intro to COB Refreshers  Defining Common Terminologies  Three Ways to Become Entitled to Medicare  Waiting Period for ESRD Entitlement  Determining Three Month Waiting Period  Determining the Initial Medicare Entitlement Reason  Helpful Hints Before Digging Deeper into COB  Incarceration

3

5 6

7

8 12 13

14

15 16 17 18 23 24 25 27 32 34 20

 COB Four-Step Process  Applying COB Formulas  Determining Date of Retirement  COB Rules for Multiple Commercial Carriers  Special Circumstances that Affect COB  COB Reference Chart  Words of Wisdom  Helpful Links

Important

This playbook is designed to assist teammates with important information pertaining to Coordination of Benefits (COB). COB plays a huge part in ensuring that coverage is set appropriately for our patients. Most patients we encounter have more than one insurance plan, so being able to set coverage correctly is what makes us world class! This playbook can be used in a variety of ways due to the information that is available. For example, you may need a quick refresher on how patients can become entitled to Medicare. Or maybe you need more information on how to set coverage if a patient is incarcerated. Maybe you have a patient that has two commercial insurances and you are not sure which plan should be billed first. You will find this information and more in this playbook. DaVita lives the core values everyday and although all of the core values are important, Continuous Improvement is a core value we strive to excel in. Because of this, our processes may change over time. If you see information in this playbook that may be outdated or needs updating, please reach out to training or your leadership. The training team will work with leadership to make sure information is updated to align with our current policies and procedures.

You can email your leadership directly or to Team StarLink .

Three Themes

Communication & Customer Service

Digging Deeper & Critical Thinking

Downstream Impact

•

Clearly Stated Expectations

•

Send Forth Ripples

•

Short-Term Impact vs Long-Term Impact Dig Deeper! Find the Root Cause!

•

Billing

•

Explain the “Why”

•

Collections

•

•

Professional and Courteous

•

Center

•

Build Relationships

All About Insurance Online Refresher

You may wish to review some basics about insurance in

ROPS1004: All About Insurance Navigate to Team StarLink’s Sand Dollars 101 StarPoint page to refresh your memory.

You can also review COB and how it may apply in the ROPS2012: Intro to Coordination of Benefits

In StarLearning.

Defining Common Terminologies

Regular Chronic Dialysis Began (RCDB) – also known as First Date of Dialysis Ever (FDODE) The first date a person is dialyzed after being diagnosed with ESRD. It is often a date in the hospital and could have occurred in another country. Name has been updated to mirror terminology in the End Stage Renal Disease Medical Evidence Report (CMS2728). When determining if a training will waive a patient’s waiting period, the count starts the first day of the month the patient starts dialysis. It is not a 90-day count from the first day of dialysis, but a 3-month count . PD/ Home Hemo/ Self Care Training in the First Three Months of Treatment Coordination of Benefits Period (COB) Specific set of rules applied by either CMS when Medicare is involved or the individual insurance carriers that determines which insurer is primary, secondary and tertiary: a specific time frame may be included. Acute Kidney Injury (AKI) Previously called Acute Renal Failure (ARF), and is an abrupt or rapid decline in renal function or kidney damage that happened suddenly. Our facilities are chronic-based. Because of this, we are unable to bill Medicare. If an AKI patient is treating in our facility and has Medicare, we may need to bill the hospital where the patient was discharged from, and may require a SPA (Single Patient Agreement).

Medicare Eligibility vs. Entitlement

Individual Policies People often mix up these two terms when discussing Medicare. The difference between the two is:  Being eligible means a patient is qualified for Medicare, meets one of the conditions for coverage and would receive it if they applied.  Being entitled means a patient is qualified for Medicare, meets one of the conditions for coverage, has applied and a Medicare ID number was issued. Coverage is active. We learned in All About Insurance that if a patient has an individual policy, Medicare will always be primary. Sometimes when verifying coverage, an insurance representative will mention “individual” when discussing benefits. In order for us to determine the possibility of a COB, it is important for us to ask questions to clarify during the call:  Is this an Individual plan that is privately purchased and not through an EGHP? (in which case Medicare would always be primary) OR  They are calling it Individual because the policy holder has no spouse or dependents on the plan. In this case, it is truly a group health plan (EGHP), and there could be a possibility of a COB.

Employer Group Health Plan (EGHP), Group Health Plan (GHP), Large Group Health Plan (LGHP) An insurance policy that is provided by an employer to an active or retired employee. This type of plan is not available to the general public for purchase. The premiums are typically paid by the employer and employee. COB may apply if patient has Medicare and an EGHP.

Medigap Policies

An insurance policy that is issued to a Medicare beneficiary, specifically as secondary to Medicare . It is issued to Medicare beneficiaries with the understanding that depending on the plan selected, it only pays the percentage that is not paid by Medicare. This is true! Medigap policies are considered to be part of the patient’s Medicare coverage, therefore an EGHP would always follow Medicare/Medigap, if Medicare is primary.

Example:

Medicare Medigap

1.

2.

EGHP

3.

Supplemental Policy An insurance policy that is secondary to Medicare. It could be an EGHP that has met the COB period or a Medigap policy. It is important to find out which when discussing coverage with an insurance company.

The United States Department of Veterans Affairs (VA) is a government-run military health coverage for U.S. veterans who were honorably discharged. Veterans Affairs (VA) Centers for Medicare & Medicaid Services (CMS) A United States federal agency which administers Medicare, Medicaid and State Children’s Health Insurance Programs. CMS has a goal to achieve a high quality health care system and aim for better care at lower costs for members, while improving their health. Medicare and Medicaid rules and guidelines are managed by CMS. Consolidated Omnibus Budge Reconciliation Act (COBRA) Law passed by the U.S. Congress that mandates employers (generally those with 20 or more employees) to provide continued health coverage after leaving employment. With COBRA, members will be responsible for the entire premium amount that was once a shared responsibility between employer and the employee. COBRA is still an EGHP since it is a continuation of employer group health coverage.

Three Ways to Become Eligible for Medicare

AGE

 65 years or older  A United States citizen

 An alien admitted for permanent residence of the United States  Part A is premium-free if patient or spouse worked for 10 years in Medicare-covered employment (must have been married for minimum of 10 years if applying under ex-spouse)  If a person is not eligible for Medicare, they can purchase Medicare and will have to pay higher monthly premiums for Part A and B

DISABILITY

 Entitled to and receiving SSDI (Social Security Disability Insurance) or Railroad Disability benefits for 24+ months plus a five month waiting period (total 29 months)  Been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also know as Lou Gehrig's disease, and receiving disability benefits for 1+ month

ESRD

 Diagnosed with End Stage Renal disease and begins a regular course of dialysis treatments

Entitlement begins on the first day of the month for everyone. For persons entitled due to Age, whose birthday is on the 1 st of the month, entitlement will begin the month PRIOR to their 65 th birthday. This is important when determining initial Medicare Entitlement reason and COB. Special Medicare Birthday Rule

Waiting Period for ESRD Entitlement

 Requires a 3-month (not 90 days) waiting period prior to Medicare entitlement  Waiting period retros back to 1 st day of month RCDB / FDODE occurred  ESRD entitlement begins the fourth month of dialysis In-center Hemodialysis

PD/Home Hemodialysis/Self-care

 Waiting period is waived if training is conducted during the first three months of treatment  ESRD entitlement begins on the first month of dialysis

Conditions for Waiving the Waiting Period *****One waiting period per patient’s lifetime*****

 Training for a specific modality is received during the initial 3- month Medicare ESRD waiting period  A kidney transplant is received during the initial 3-month Medicare ESRD waiting period  If a patient previously received a kidney transplant that was successful for 36+ consecutive months, but later returns to outpatient dialysis due to ESRD  If a patient regained kidney function for 12+ consecutive months, but later returns to outpatient dialysis due to ESRD

Determining Three-Month Waiting Period

Did pt. receive training for a self care modality during first 3 months of treatment start date?

Did pt. receive a transplant during first 3 months of treatment start date?

WAITING PERIOD WAIVED

Is pt. returning to dialysis after 36+ months of having a successful kidney transplant?

Is pt. returning to dialysis after 12+ months of regaining Kidney function?

WAITING PERIOD WILL APPLY

In-center hemo or nocturnal hemo dialysis with no training or transplant during first 3 months of treatment start Date?

Determining the Initial Medicare Entitlement Reason

Does patient have Medicare at ESRD entitlement? If NO , not dually entitled at ESRD entitlement date.

If YES , what is the Medicare Part A entitlement date compared to patient’s age and ESRD entitlement date?

Dually entitled at ESRD entitlement date. Age is the initial reason.

AGE, then ESRD

Dually entitled at ESRD entitlement date. Disability is the initial reason.

DISABILITY, then ESRD

NOT DUALLY ENTITLED! Disability record will drop, initial reason changes to Age.

DISABILITY, then AGE

DISABILITY, then ESRD, then AGE

Dually entitled at ESRD entitlement date. Disability is the initial reason.

If initial entitlement is Disability, upon turning 65, the initial reason changes to Age, per CMS. However, if due to Disability and that person next becomes dually entitled due to ESRD, then later turns age 65, Disability is retained as the initial entitlement reason. ESRD entitlement must happen between Disability and Age entitlement for Disability to be retained as the initial reason.

Helpful Hints Before Digging Deeper into COB

** Remember, the patient must be covered under an EGHP for a 30-month COB period to be possible. **

Medicare will always be primary over:

Medicare and Veterans Affairs (VA) Medicare and VA are both federally- funded programs, therefore DaVita should not have both programs together in a patient’s coverage string. In other words, we should never have Medicare and VA set for the same claim in primary, secondary or tertiary positions. If ESRD was caused by a service related injury, VA is responsible for the care of the patient. If VA cannot provide the service due to not having a facility or hospital in a nearby area, they may provide an authorization for the care to be outsourced.

 Medicaid / Managed Medicaid  Medigap Plans  True supplement plans that would not pay if the patient didn’t have Medicare  State Renal Plans  Indian Health Services (IHS)  TRICARE for Life  CHAMPVA  Individual commercial policies  Example: Self–employed patient purchases Cigna plan for their family. Since

they are self-employed, there is no “employer group”

For ESRD injury claims, Medicare will never be primary over:

 Worker’s Compensation plans  Liability policies  No-fault insurance claims (Such as auto liability)

INCARCERATION

When a patient is incarcerated, they will not immediately lose Medicare. Medicare Part A will remain active, however, it will be suspended during incarceration. The patient can potentially lose Part B if premiums are not paid on time, and will have to re-enroll when patient is released from prison.

For billing purposes, DaVita will bill either the local jail or third party administrator who’s contracted with the jail, while the patient is incarcerated. Medicare will not pay for dialysis.

* From www.ssa.gov/pubs/EN-05-10133.pdf and mymedicarematters.org

COB Four-Step Process

1. Verify when Regular Chronic Dialysis Began (RCDB) / First Date of Dialysis Ever (FDODE)

2. Verify if there is a 3-month waiting period

3. Verify initial Medicare entitlement reason

4. Follow the flow chart for:

ESRD

AGE

DISABILITY

Is there an EGHP?

Is there an EGHP?

If No, there is no COB and Medicare is prime

If No, there is no COB and Medicare is prime

If Yes

If Yes

Is the Policy holder currently employed (as of ESRD Entitlement)? If No, there is no COB and Medicare is prime

Is the Policy holder currently employed (as of ESRD Entitlement)? If No, there is no COB and Medicare is prime

Is there an EGHP?

If No, there is no COB and Medicare is prime

If Yes

If Yes

If Yes

Are there 20 or more employees in the group? If No, there is no COB and Medicare is prime

Are there 100 or more employees in the group? If No, there is no COB and Medicare is prime

Add 30 months to date entitled due to ESRD!

If Yes

If Yes

Add 30 months to date entitled due to ESRD!

Add 30 months to date entitled due to ESRD!

Applying the Medicare COB Formulas

• COB is 30 months ( **hint** 30 months = 2 years + 6 months)

• COB period is in addition to the 3-month waiting period, if applicable

• Based off the ESRD entitlement date (i.e. 30 months begin on that date)

• Retro entitlement to the first of the month (RCDB/FDODE 1/17, retro to 1/1)

Example is an in-center hemodialysis patient with no training or transplant during waiting period; not previously dialyzed in lifetime

(RCDB/FDODE) ___________ + Waiting Period___________

03/16/2012 3 months 06/01/2012 06/01/2012 06/01/2014 12/01/2014 12/01/2014

(retro back to the 1st of the month) = Medicare Entitlement due to ESRD

Add + 2 years___________ Add + 6 months___________

= Medicare Primary date

COB End Date is 11/30/2014

Creating a Timeline for a Patient

In our example, our patient’s name is Jack. In order to figure out Jack’s correct initial Medicare entitlement reason, we need to plot what happened for him on a timeline.  Jack is under Age 65 and began dialysis on 12/5/2013. He has had no training or transplant within the first 3 months of dialysis, nor has ever dialyzed before. Jack obtained Medicare on 2/1/2014.

MEDICARE A&B Entitlement

ESRD Entitlement

RCDB / FDODE

 We conclude Jack’s Initial Medicare Entitlement reason is DISABILITY because that entitlement came before the ESRD entitlement date.  We always have to keep in mind the patient’s 3 month waiting period. Medicare entitlement was before 3 month waiting period was over.

Calculating COB for a Patient

In our example, our patient’s name is Amy. In order to figure out whether a COB applies to Amy, we need to know her initial entitlement reason. Amy is under Age 65, not disabled, began dialysis on 12/18/2015. She had no training or transplant within the first 3 months of dialysis, but had a successful transplant back in 2003. Amy’s husband is the subscriber on an EGHP policy from Cigna and is working full time for a large employer group.

Successful transplant

ESRD Entitlement

RCDB / FDODE

 We conclude Amy’s initial Medicare entitlement reason is ESRD because she is under 65 and is not disabled.  Based on the ESRD entitlement reason, the subscriber must be currently working for the policy to coordinate ahead of Medicare. Since her husband is the employee and currently works for a large group, 30-month COB will apply.  Due to successful transplant in 2003, 3 month waiting period is waived.  If we count the 30 months, Medicare will become primary 6/1/2018.

Determining Date of Retirement

If a patient cannot remember his/her, or his/her spouse’s, retirement date as it relates to coverage through an EGHP, follow the guidelines below as set forth by the CMS.

Scenario #1

Scenario #2

Scenario #3  If a patient or their spouse worked past the patient’s Medicare Part A entitlement date, but the patient/spouse retired less than five years ago and cannot recall their own or their spouse’s retirement date, we must obtain the retirement date from appropriate

 If a patient cannot recall his/her, or his/her spouse’s, date of retirement, but knows it occurred prior to their

 If a patient worked beyond his/her Medicare Part A entitlement date, had coverage under a group health plan during

Medicare Part A entitlement date as shown on his/her Medicare card, report the Medicare Part A entitlement date as the retirement date.

that time, and cannot recall his/her or their spouse’s exact retirement date, but knows it has been at least five years since retirement, enter the retirement date as five years retrospective to

informational sources; e.g.

the date of admission / treatments.

former employer or supplemental insurer.

COB Rules for Multiple Commercial Carriers

EGHP vs. Individual

Subscriber Rule

Effective Date Rule If covered by two EGHPs, the policy with the earliest effective date is primary

Per CMS, EGHP plans are always primary over Individual Plans (non-Medigap coverage)

The policy holder’s policy is primary over another policy where they are a covered dependent

A person covered by two EGHPs, one through active employment and one as a retiree– the policy through active employment is primary, regardless of who owns the policy Retiree Rule

Birthday Rule

Gender Rule If a dependent is covered by more

If a dependent is covered by more

than one EGHP with different subscribers, the primary policy will be based off of whoever’s birth date (MM/DD) occurs first

than one EGHP with different subscribers and the Birthday rule is not followed, when possible, the male subscriber’s policy is primary over the female subscriber’s policy

Divorce/Legal Separation Rule

If a dependent (child) is covered by an EGHP from each parent who is divorced or legally separated (or never married), the primary policy is determined by

The court

o

o If the court does not determine the primary policy, it is determined by the custody agreement  Legal custodial parent’s policy is primary  Joint custody follows the Birthday rule to determine the primary policy

Special Circumstances That Affect COB

Working Status

 Defined as a person who’s actively employed, not actively employed but is paying FICA (less than 6 months), retains employment rights and not yet terminated  Medicare considers the policyholder to be working when:

They are actively employed



They are not actively employed but:



 Less than 6 months into disability leave (still paying FICA)

 Retains employment rights, not yet terminated by the employer not yet considered a COBRA (example: consultant work)  If on disability for longer than 6 months, regardless of work status, Medicare will become primary

Kidney Transplant

 If a patient returns to dialysis within 36 months of having a kidney transplant, their COB will continue uninterrupted  If a patient has a kidney transplant that lasts for more than 36 months, a new COB period may apply, if other conditions are met  No new waiting period would apply if patient returns to dialysis  Kidney transplant prior to RCDB / FDODE – when patients have kidney failure and are able to receive a transplant prior to their first dialysis treatment, the date of transplant will be considered their FDODE. This is important for COB should the kidney fail and patient needs dialysis

Regained Function

 If a patient regains their kidney function and is able to discontinue dialysis, but must return to dialysis prior to 12 months, their COB will continue uninterrupted  If the patient’s kidney function is regained for more than 12 months ,and they later return to dialysis, a new COB period may apply.  No new waiting period would apply

COBRA Plans

 If a patient has a COBRA PRIOR TO Medicare entitlement, the COBRA can potentially terminate  If a patient is entitled to Medicare PRIOR TO obtaining COBRA, COBRA policy and state law need to be reviewed to determine whether policy will remain active and whether a COB could apply

 COBRA is still an EGHP, as it is a continuation of employer group coverage

Exchange Plans  Due to the Affordable Care Act (ACA) in 2013, individuals can purchase medical health coverage through the Health Insurance Exchange Marketplace for their state. When they purchase a plan through the exchange, it is considered an individual medical plan. If a patient purchases an exchange plan and has Medicare A and B, Medicare will always be the primary payer  Small employers of 50 full-time employees or less can offer medical (and dental) coverage through the exchange. They will do this using the Small Business Health Options Program (SHOP) Marketplace. When you verify a patient who has a medical plan through the SHOP Marketplace, be aware that COB may still apply, depending on Medicare entitlement reason. 1. Patient has Medicare due to ESRD, Medicare will be secondary to the SHOP plan. 2. Patient has Medicare due to Age and is still employed, Medicare will be secondary to the SHOP plan. 3. Patient has Medicare due to Disability (through spouse who’s still employed), Medicare will be primary due to amount of employees. Examples:

COB Reference Chart 2013

Regular Chronic Dialysis Began (RCBD) / First Date of Dialysis Ever (FDODE)

3 Month waiting period + 30 month COB period = date Medicare is primary

No waiting period + 30 month COB period = date Medicare is primary

Renal Chronic Dialysis Began (month and year)

January

2013

July 1

2015

October 1

2015

February

2013

August 1

2015 November 1

2015

March

2013 September 1

2015 December 1

2015

April

2013

October 1

2015

January 1

2016

May

2013 November 1

2015

February 1

2016

June

2013 December 1

2015

March 1

2016

July

2013

January 1

2016

April 1

2016

August

2013

February 1

2016

May 1

2016

September

2013

March 1

2016

June 1

2016

October

2013

April 1

2016

July 1

2016

November

2013

May 1

2016

August 1

2016

December

2013

June 1

2016 September 1

2016

For a complete Reference Chart for dates from January 2005 – December 2021 , click here

COB Reference Chart 2014

Regular Chronic Dialysis Began (RCBD) / First Date of Dialysis Ever (FDODE)

3 Month waiting period + 30 month COB period = date Medicare is primary

No waiting period + 30 month COB period = date Medicare is primary

Renal Chronic Dialysis Began (month and year)

January

2014

July 1

2016

October 1

2016

February

2014

August 1

2016 November 1

2016

March

2014 September 1

2016 December 1

2016

April

2014

October 1

2016

January 1

2017

May

2014 November 1

2016

February 1

2017

June

2014 December 1

2016

March 1

2017

July

2014

January 1

2017

April 1

2017

August

2014

February 1

2017

May 1

2017

September

2014

March 1

2017

June 1

2017

October

2014

April 1

2017

July 1

2017

November

2014

May 1

2017

August 1

2017

December

2014

June 1

2017 September 1

2017

For a complete Reference Chart for dates from January 2005 – December 2021 , click here

COB Reference Chart 2015

Regular Chronic Dialysis Began (RCBD) / First Date of Dialysis Ever (FDODE)

3 Month waiting period + 30 month COB period = date Medicare is primary

No waiting period + 30 month COB period = date Medicare is primary

Renal Chronic Dialysis Began (month and year)

January

2015

July 1

2017

October 1

2017

February

2015

August 1

2017 November 1

2017

March

2015 September 1

2017 December 1

2017

April

2015

October 1

2017

January 1

2018

May

2015 November 1

2017

February 1

2018

June

2015 December 1

2017

March 1

2018

July

2015

January 1

2018

April 1

2018

August

2015

February 1

2018

May 1

2018

September

2015

March 1

2018

June 1

2018

October

2015

April 1

2018

July 1

2018

November

2015

May 1

2018

August 1

2018

December

2015

June 1

2018 September 1

2018

For a complete Reference Chart for dates from January 2005 – December 2021 , click here

COB Reference Chart 2016

Regular Chronic Dialysis Began (RCBD) / First Date of Dialysis Ever (FDODE)

3 Month waiting period + 30 month COB period = date Medicare is primary

No waiting period + 30 month COB period = date Medicare is primary

Renal Chronic Dialysis Began (month and year)

January

2016

July 1

2018

October 1

2018

February

2016

August 1

2018 November 1

2018

March

2016 September 1

2018 December 1

2018

April

2016

October 1

2018

January 1

2019

May

2016 November 1

2018

February 1

2019

June

2016 December 1

2018

March 1

2019

July

2016

January 1

2019

April 1

2019

August

2016

February 1

2019

May 1

2019

September

2016

March 1

2019

June 1

2019

October

2016

April 1

2019

July 1

2019

November

2016

May 1

2019

August 1

2019

December

2016

June 1

2019 September 1

2019

For a complete Reference Chart for dates from January 2005 – December 2021 , click here

COB Reference Chart 2017

Regular Chronic Dialysis Began (RCBD) / First Date of Dialysis Ever (FDODE)

3 Month waiting period + 30 month COB period = date Medicare is primary

No waiting period + 30 month COB period = date Medicare is primary

Renal Chronic Dialysis Began (month and year)

January

2017

July 1

2019

October 1

2019

February

2017

August 1

2019 November 1

2019

March

2017 September 1

2019 December 1

2019

April

2017

October 1

2019

January 1

2020

May

2017 November 1

2019

February 1

2020

June

2017 December 1

2019

March 1

2020

July

2017

January 1

2020

April 1

2020

August

2017

February 1

2020

May 1

2020

September

2017

March 1

2020

June 1

2020

October

2017

April 1

2020

July 1

2020

November

2017

May 1

2020

August 1

2020

December

2017

June 1

2020 September 1

2020

For a complete Reference Chart for dates from January 2005 – December 2021 , click here

Words of Wisdom from COB Experts Throughout our Neighborhoods

If a patient had a transplant that lasted more than 3 consecutive years, a new 30-month COB period may apply

If the patient kept Medicare after a 3-year viable transplant, but the Medicare Common Working File (CWF) data indicator is a 2 (ESRD), GHI needs to be contacted; a new 30-month COB will probably occur

The date the patient returned to dialysis, post the 3-year transplant, becomes the new RCDB / FDODE

The 3 month waiting period is waived for ESRD entitlement

If a patient regained kidney function for more than one year, a new RCDB / FDODE is applicable

The 3 month waiting period is waived for ESRD entitlement

Words of Wisdom from COB Experts Throughout our Neighborhoods

Hemodialysis / Nocturnal Hemo – 3-month wait for Medicare entitlement PD/Home Hemo/Self Care – 3-month waiting period waived

The CMS 2728 form must indicate training started within the first 3 months of the RCDB / FDODE start date

Modality

Initial Medicare Entitlement Due to:

First reason patient would be entitled to Medicare if they had applied timely

ESRD

30-month COB

Patient has an EGHP

Patient covered by EGHP & policy holder must be currently employed & group must have 20 or more employees at the time patient is entitled for Medicare due to ESRD Patient covered by EGHP & policy holder must be currently employed & group must have 100 or more employees at the time patient is entitled for Medicare due to ESRD

If Medicare entitlement due to Age and ESRD occur in the same month, ESRD takes precedence

Age

If Medicare entitlement due to Disability & ESRD

Disability

occur in the same month, ESRD takes precedence

If patient was initially entitled to Medicare due to Disability, and turns 65 before ESRD entitlement, initial entitlement becomes Age

Here are some helpful links and resources for more information regarding ESRD and COB

STARPOINT

EXTERNAL SITES • www.cms.gov •

www.medicare.gov

•

www.emblemhealth.com/glossary

•

http://questions.medicare.gov

•

http://www.esrdncc.org/ www.socialsecurity.gov

•

•

Medicare: Who Pays First -PDF Medicare and Incarceration – PDF Medicare HIC Number Suffixes

•

RRS TRACK

•

If you come across a COB scenario not described in this playbook, please contact your leadership for guidance.