Medicare Can Start Sooner with Home Training

Do you have patients who don’t have good coverage, but can’t start home training right away because of your schedule or theirs? Do you have patients who need to have Medicare sooner and want to do CCPD, but supply shortages limit their access to that treatment? Do you have patients who aren’t sure if they want to go home and need dialysis right away? In all of these situations, patients may be able to get retroactive Medicare.

Some dialysis staff—including social workers—believe the Medicare’s effective date is the first day of the month home training starts. That’s not the case. If the patient and/or care partner starts a training program before the 4th month of dialysis (the “qualifying period”), Medicare can be retroactive to the 1st day of the month they dialysis starts in any setting (hospital, clinic, or even at home). The instructions for how to complete the Chronic Renal Disease Medical Evidence Report (CMS 2728), asks on pages 1 and 2 for the clinic to report:

• The date chronic (regular) dialysis began (any setting)

• When dialysis started at the dialysis clinic

• The date the patient started home training

• The date training was completed or is expected to be completed.

In case Social Security staff are not aware of Medicare backdating, here’s the link to the Social Security Program Operations Manual and the policy about when Medicare starts for someone with kidney failure who starts home training.

Some patients want to do CCPD, but are on a waiting list for training because CCPD solution is in short supply now. Rather than starting in-center HD if the wait for CCPD solutions will be longer than 3 months, consider training them to do CAPD and how to incorporate the four exchanges into their daily lives, including their work schedule. Knowing and gaining expertise in doing CAPD and infection control precautions with four connections/disconnections should help them do better on the cycler, appreciate that treatment more, and feel more secure doing CAPD if the power goes out or they want to travel without their cycler.

Some patients start dialysis emergently because they haven’t seen a doctor or because they’re in denial and don’t want to admit that they have symptoms of kidney disease. Usually they have not received education about all treatment options. They may be unsure if they want to take on the responsibility for doing their own treatments. If they have no or limited insurance, knowing that Medicare may start sooner could help them look at home dialysis in a positive way. Starting potential home dialysis candidates on in-center dialysis, having well-adjusted home dialysis patients who do different treatments serve as mentors, and having the home training nurse or another nurse who knows about all treatment types provide fact-based modality education can help more patients consider home options before that critical end of the third month of dialysis. Some clinics do this in a separate section where new patients can get more attention and education.

It’s important to identify which patients could use Medicare right away so you can prioritize your training schedule for those patients as well as for patients whose jobs depend on having to spend fewer hours at dialysis. Doing this can help you assure that more of your patients have their dialysis and other medical care covered. This will help your dialysis clinic’s revenues and help relieve the stress your patients may feel facing the large financial burden that 3 months of dialysis without insurance can cause.