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 End-Stage Renal Disease (ESRD) and Medicare

ESRD 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 Payer responsibilities 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 This email address is being protected from spambots. You need JavaScript enabled to view it., 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. About the author: Kea Nielsen is the Director of Client Services and Compliance at Renalogic. In her role she has operational oversight of the cost containment operations for Renalogic which includes managing the claims team, plan document review, corporate legal assistant, appeals management and quality assurance. In addition she is the Chief Compliance Officer for privacy and security. Kea has been with Renalogic since April 2007 and has been instrumental in the growth of the cost containment division. She came to Renalogic with a history of Office Management for healthcare providers and has over 15 years of healthcare experience in management roles.