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| Stethoscope Photo by Bill Oxford on Unsplash |
The recipient of an MD from the Washington University School of Medicine, Dr. Pachavit Kasemsap is a former senior medical director at Highmark Inc. While working at Highmark, Dr. Pachavit Kasemsap pursued additional revenue for MA members with ESRD from the Centers for Medicare & Medicaid Services.
A medical condition in which the kidneys cease to function on a permanent basis, ESRD, also known as end-stage renal disease or chronic kidney disease stage 6, is a chronic renal failure that requires a constant course or long-term dialysis or a kidney transplant to save the life the patient. Based on ESRD, many patients may become entitled to Medicare coverage. Medicare is a secondary group health plan payer for individuals entitled to Medicare coverage based on ESRD for a period of 30 months regardless of whether the coverage is based on employment status.
Medicare coverage can begin at various stages. For example, Medicare-covered treatments can start in the first month of dialysis if the beneficiary participates in a home dialysis training program in any Medicare-approved training facility. Medicare treatment can also begin when the patient attends home dialysis training before the third month of the dialysis or when the beneficiary is about to complete home dialysis training and start self-dialysis treatment. Also, Medicare coverage can start at the month a beneficiary is admitted to any Medicare-approved hospital for a kidney transplant or health services required prior to the transplant, or two months before the transplant if the transplant is delayed after the beneficiary is admitted to the hospital.
If the Medicare care coverage is based on ESRD only, it is expected to end 12 months after the beneficiary stops getting dialysis treatments, or 36 months after the beneficiary undergoes a kidney transplant.
