What Is This Application?

Created by Jarrod Caldwell — AI Specialist | Learning Architect

ESRD CoordCheck is a Browser-Native Learning Application™ (BNLA) — a new category of interactive training that runs entirely in your web browser with zero infrastructure. No LMS login. No software install. No authoring tool subscription. Just open the file and learn.

This simulator builds competency in Medicare Secondary Payer (MSP) rules specific to End-Stage Renal Disease (ESRD) patients, focusing on the 30-month coordination period — the critical window that determines whether a Group Health Plan (GHP) or Medicare pays as the primary insurer. It combines a Reference Library of CMS guidelines with scenario-based practice questions featuring realistic patient cases, plus a built-in CoordCheck Calculator for verifying eligibility dates in real time.

What is a BNLA? Browser-Native Learning Applications represent a new frontier in instructional design — AI-engineered, performance-grounded interactive training delivered as a single portable file. No servers. No plugins. No vendor lock-in. Learning science meets software engineering, built with AI, delivered by the browser.

Who is this for?

🏥 Patient Access Representatives 📋 Billing & Coding Specialists 👩‍⚕️ Nurses & Care Coordinators ⚖️ Compliance Officers 💰 Revenue Cycle Staff 🎓 New Hire Onboarding

📍 How to Use This Training

Start with the Reference Library to review CMS guidelines, MSPQ Part III rules, eligibility paths, and dual entitlement logic.
When ready, launch Start Scenarios to work through 6 realistic patient cases that test your understanding.
Read each patient profile carefully, then select the best answer from the options provided.
After answering, review the feedback and CMS citation to reinforce the correct rule.
Use the CoordCheck Calculator in the sidebar to verify dates during scenarios.
Retake the scenarios as many times as needed — practice builds mastery.

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Reference Library

CMS guidelines, MSPQ rules, eligibility paths & worked examples

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Start Scenarios

6 interactive patient cases with instant feedback

📚 ESRD CoordCheck Reference Library

Official CMS Guidelines for the 30-Month Coordination Period

Jarrod Caldwell — AI Specialist | Learning Architect

ESRD Guidelines — Three Core Rules

Generally, there is a 3-month eligibility waiting period to enroll in Medicare after a regular course of dialysis begins.
All or a portion of the 3-month waiting period may be waived if:
- The patient participates in a self-dialysis training program
- The patient has a kidney transplant within the 3-month waiting period

If the individual has GHP, the GHP pays primary for 30 months. The 30 months is the coordination period. Medicare pays secondary.
The 30-month coordination period begins the first day of the month the individual becomes entitled to enroll in Medicare due to ESRD.

If the individual has COBRA coverage, COBRA is primary during the 30-month coordination period. Medicare is secondary.
Medicare will become primary after the 30-month coordination period if ESRD-based eligibility continues.

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Key Takeaways

3-Month Waiting Period

Standard Medicare eligibility for ESRD = 1st day of 4th month of dialysis. Can be waived with self-dialysis training or transplant within 3 months.

30-Month Coordination Period

GHP (or COBRA) pays PRIMARY for 30 months from Medicare eligibility date. Medicare pays secondary. After 30 months, Medicare becomes primary.

Employer Size Does Not Matter

Unlike Working Aged (20+) or Disability (100+) MSP rules, ESRD coordination applies regardless of employer size.

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MSPQ Part III: ESRD Medicare Entitlement

Part III. Information About the Patient If ESRD Medicare Entitlement Applies (Including Dual Entitlement: Age and ESRD or Disability and ESRD)

4. Are you within the 30-month coordination period?

Note: The 30-month coordination period starts the first day of the month an individual is eligible for Medicare (even if not yet enrolled in Medicare) because of kidney failure (usually the fourth month of dialysis) regardless of entitlement due to age or disability. If the individual is participating in a self-dialysis training program, or has a kidney transplant during the 3-month waiting period, the 30-month coordination period starts with the first day of the month of dialysis or kidney transplant.

Critical Points from Part III

1. Coordination period starts at ELIGIBILITY, not enrollment
2. Usually 4th month of dialysis (or 1st month with self-training/transplant)
3. Applies regardless of age or disability entitlement
4. Must calculate the period start date to answer Q4 correctly

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Part III Decision Flow

Q4: Are you within the 30-month coordination period?

NO → Medicare is Primary

YES → Continue to Q5

Q5: Entitled to Medicare on ESRD + Age OR ESRD + Disability?

NO → GHP Primary 30 mo

YES (Dual) → Continue to Q6

Q6: Was INITIAL entitlement based on ESRD?

YES → GHP Primary

NO → Continue to Q7

Q7: Does Working Aged or Disability MSP apply?

YES → GHP Primary

NO → Medicare Primary

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Medicare Eligibility Dates for ESRD

Standard Path: In-Center Dialysis

Medicare eligibility = 1st day of 4th month of regular dialysis.

Dialysis Month 1 → Month 2 → Month 3 → Month 4 Day 1 = Eligible

Example

Dialysis starts March 15, 2024
March=1, April=2, May=3 → Eligibility = June 1, 2024

Exception: Self-Dialysis Training

If participating in self-dialysis training within first 3 months → eligibility = 1st day of month dialysis started

Self-Training in First 3 Months = Month 1 Day 1 = Eligible

Exception: Kidney Transplant

If transplant within 3 months → eligibility = 1st day of month of transplant

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The 30-Month Coordination Period

When Does It Start?

Starts the first day of the month an individual is ELIGIBLE for Medicare (even if not enrolled) because of kidney failure.

During the 30-Month Period

GHP pays PRIMARY (or COBRA if applicable). Medicare pays secondary. Applies regardless of employer size. Patient does not have to enroll in Medicare immediately.

After 30 Months

Medicare automatically becomes primary on Month 31, regardless of employment status.

Complete Timeline Example

Dialysis Starts: March 18, 2024
Medicare Eligibility: June 1, 2024 (4th month)
30-Month Period: June 1, 2024 – November 30, 2026
Medicare Primary: December 1, 2026

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Dual Entitlement Rules

Patients can be entitled to Medicare on multiple bases: Age (65+), Disability, and/or ESRD.

Initial Entitlement = ESRD

If first Medicare entitlement was ESRD → GHP pays primary for 30 months.

Initial Entitlement = Age or Disability (ESRD comes later)

Check MSPQ Q7: Does Working Aged or Disability MSP already apply? If yes, GHP stays primary during coordination.

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Worked Examples

Example 1: Standard Patient

Age 52, starts dialysis October 15, 2024, no self-training
Eligibility: January 1, 2025
GHP Primary: Jan 2025 – June 2027

Example 2: Self-Training

Age 48, starts dialysis August 20, 2024, WITH self-training
Eligibility: August 1, 2024 (waived wait)
GHP Primary: Aug 2024 – Jan 2027

Example 3: Past 30 Months

Started dialysis Jan 2021, eligibility April 1, 2021
Today: December 2024 (Month 44)
Q4 = NO → Medicare is Primary

ESRD CoordCheck

Browser-Native Learning Application

Jarrod Caldwell — AI Specialist | Learning Architect

Question 1 of 6

Score

/ 6

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CoordCheck Calculator

Eligibility & period dates

Dialysis Start Date

Self-Dialysis Training

Medicare Eligibility --

Coordination Ends --

Medicare Primary --

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Quick Reference

CMS rules at a glance

Standard Eligibility

1st day of 4th month of dialysis

Self-Training Exception

1st day of month dialysis started

30-Month Start

Begins at ELIGIBILITY date

GHP/COBRA Primary

30 months (any employer size)

After 30 Months

Medicare becomes primary

ESRD CoordCheck

What Is This Application?

📍 How to Use This Training

📚 ESRD CoordCheck Reference Library

Training Complete!