Скачать или смотреть Part 4 ESRD Dual Entitlement Logic

Part 4 – ESRD, Dual Entitlement & the 30-Month Rule
COB Master Class | Medicare Secondary Payer (MSP)

End-Stage Renal Disease (ESRD) introduces a time-based Medicare Secondary Payer (MSP) rule that overrides many assumptions auditors make about employer size, employment status, and entitlement hierarchy.

In Part 4 of the COB Master Class, Allen Horn walks through real-world ESRD scenarios, showing exactly when the 30-month coordination period applies—and when it does not—using Medicare’s official “snapshot” logic.

This episode is heavily case-study driven, making it ideal for COB auditors, MSP analysts, recovery teams, medical billers, and compliance professionals.

🔍 In This Video, You’ll Learn:
🧠 Core ESRD MSP Rules

What qualifies as End-Stage Renal Disease (ESRD)

How the 30-month coordination period is triggered

Why employer size does NOT matter for ESRD MSP rules

When GHP pays primary and when Medicare becomes primary

📸 The “Snapshot” Rule (Critical!)

How to determine who was primary immediately before ESRD

Why this single moment decides whether the 30-month period applies

Common audit mistakes caused by skipping this step

⚖️ Dual Entitlement Hierarchy

Age vs. Disability vs. ESRD

Why Age rules override Disability rules

How ESRD interacts differently than other MSP categories

🧪 Real-World Case Studies

Case 1: Small Group Exception

Medicare already primary → 30-month rule does NOT apply

Case 2: Working Aged / Disability Transition

GHP primary before ESRD → 30-month rule DOES apply

🛠️ Auditor Workflow & Best Practices

Verifying entitlement reason (Age, Disability, ESRD)

Confirming First Date of Dialysis (FDOD)

Calculating the 30-month window correctly

Applying proper status codes and documentation

Updating trackers with Medicare representative confirmation

These rules are governed by Medicare and enforced by the Centers for Medicare & Medicaid Services—making precision and documentation non-negotiable.

👨‍🏫 Meet Your Instructor

Allen Horn is a professional Coordination of Benefits (COB) auditor with deep expertise in Medicare Secondary Payer compliance, ESRD coordination, and audit workflow design. This Master Class is built from real audit files, not textbook summaries.

📘 About the Series

This is Part 4 of a 10-part COB Master Class designed to turn complex MSP regulations into repeatable audit logic.

👉 Subscribe and enable notifications so you don’t miss upcoming modules on:

Advanced ESRD overlaps

Retroactive liability recovery

High-risk MSP audit scenarios

🔖 Hashtags

#MedicareSecondaryPayer
#ESRD
#DualEntitlement
#COB
#InsuranceAuditing
#MSPRules
#MedicareCoordination
#HealthInsurance
#COBMasterClass