CROWNWeb
At this time, CROWNWeb is projected to be rolled out to all dialysis facilities (except for V.A. units) in February of 2012. In preparation for this, CMS has said that every facility needs to have at least two people registered to use CROWNWeb. One as a Security Official (formerly the Security Administrator or SA), and one DIFFERENT person to be the End-User Manager (EUM). Network #15 strongly recommends having at least one additional person registered as either a "regular user" or as a backup Security Official (formerly SA.) For more information please see our CROWNWeb Page.
TOPIC - Telephonic Open Participation Information Call
In 2006 Network #15 began hosting a series of monthly conference calls designed to improve the quality, accuracy, and timeliness of the data that we receive. These calls provide an opportunity for facilities to learn about CMS/Network forms and to open up discussions between facilities and the Network.
December 2011 Data TOPIC Call: Year-End Survey (2744) – Timeline and Important Tips - Replay Now Available
- Replay Toll-free Phone: 888-203-1112
- Replay Passcode: 73660636
- Handouts (pdf) - Please download these prior to listening to the replay
- Short Online Survey - to be taken after the call, shows who attended and provides NW 15 with feedback about the call
NOTE: Daylight Saving Time has ended, so Arizona is now THE SAME as everyone else in the Mountain Time Zone.
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Data Notes
2011 Data Notes
2010 Data Notes
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Network Patient Activity Report (PAR)
PARs must be faxed to Network #15 at 303-860-8392 and are
due by the 10th day of the month. NEVER email PARs (or any other
patient information).
Tips On Completing The PAR
- NEVER REPORT ACUTE PATIENTS. If a nephrologist is waiting to see if the patient is truly end-stage, you should NOT report this patient on the PAR—until/unless the doctor says they are chronic.
- Please PRINT legibly or, better yet, use the Excel Spreadsheet version of the PAR which can be downloaded here.
- Always write your 6-digit Medicare Provider Number at the top of the page. Facilities in AZ always have 03 as the first two digits, CO starts with 06, NM starts with 32, NV starts with 29, UT starts with 46, and WY begins with 53. Do NOT use a 3 or 4 digit “corporate” number.
- Include your FULL Provider name. “RCG Dialysis” or “Phoenix Dialysis” is NOT acceptable.
- Be sure to complete every applicable column on the PAR. People frequently forget to include the patient’s local zip code, current modality, and often don’t indicate the sending/receiving facilities (applicable when patients have transferred in or out).
- Do NOT report Transfer In/Out events for transients/visitors. Patients who were visiting from another outpatient unit for less than 30 days—with no intention of permanently changing facilities—are transient/visitors. NEW patients should always be reported regardless of how long they stay.
- Backup Hemodialysis: PD patients who require backup hemodialysis should be reported on a PAR ONLY if they remain on hemodialysis for longer than 30 days. In those cases, the modality shift or transfer-in date should reflect the date of the patient’s first backup treatment.
- New ESRD vs. Transfer In: If your facility is the FIRST chronic outpatient unit to provide dialysis, you must list a “New ESRD” event on the PAR and send a 2728. “Transfer In” applies to patients who start outpatient treatments at a different chronic facility and then transfer into your unit (these patients will already have a 2728 form).
- Interruption in Service vs. Transfer Out: If a patient enters a hospital, rehab facility, or other long-term care unit, this is not a transfer out (even if your facility has “discharged” the patient); this is an interruption in service and should be listed as such on the PAR. Use the date the patient actually left your unit, not 30 days after the patient left, or some other “discharge” date.
- Discontinue vs. Death: You must ALWAYS report death events for patients who die after stopping dialysis (within 30 days). You may list a discontinue event, by itself, when a patient has stopped dialysis and is still living at the time you submit your PAR.
- Modality shifts: Modality shift ONLY pertains to people who are still at your unit and have changed the type of dialysis they receive. ** If your unit only has an in center hemo department (and no PD department) then you would NEVER have modality shift events.
- Dialysis After Transplant: Does not apply to “kick-start” dialysis that sometimes follows a kidney transplant. This event is only used when a physician determines that the new kidney has utterly failed and chronic, outpatient dialysis must be administered.
- NEVER email PARs - or any other patient information.
Patient
Events Requiring Forms
New ESRD
Patient - Patient
has been diagnosed as ESRD and receives his/her first-ever outpatient,
chronic dialysis treatment. A CMS 2728 form must be submitted.
Transfer
In, Category A - Patient transfers into dialysis facility having previously dialyzed
at an ESRD-Medicare Certified Provider. Reported via the monthly
PAR.
Transfer
In, Category B - Patient
transfers into dialysis facility having previously only dialyzed
in another country or in prison. This will be the patients first outpatient, chronic treatment at an ESRD-Medicare Certified
Provider. A CMS 2728 form must be submitted.
Restart - Patient previously stopped dialysis treatment and is now resuming
long-term, outpatient dialysis. If it has been over 12 months
since last treatment, a new 2728 form must be submitted.
Dialysis
after Transplant Failed - Patient has rejected a transplant
and is receiving his/her first post-transplant, outpatient dialysis. If 3 years have elapsed since transplant occurred requires a
new 2728 form - otherwise only reported via PAR.
Transfer-Out for Transplant - Patient leaves facility to receive a transplant. Reported via the monthly PAR.
Transfer
Out, Category A - Patient transfers long-term (over 30 days)
to another ESRD-Medicare Certified Dialysis Provider. Reported
via the monthly PAR.
Transfer
Out, Category B - Patient leaves facility to receive long-term
(over 30 days) dialysis in another country or prison. Reported
via the monthly PAR.
Discontinue - Patient stops dialyzing after specifically articulating the decision
to permanently stop dialysis. Facility still needs to track patient
for 30 days after discontinue event, and report to Network any status
change (death, recover function). If death occurs within 30 days
facility is responsible for turning in a 2746 death notification. Reported via the monthly PAR.
Death - May be reported via PAR, or directly from 2746 form. If patient
discontinues dialysis or enters long-term care facility, dialysis
facility is still responsible for submitting 2746 if death
occurs within 30 days.
Recover
Function - Patient regains renal function of his/her native
kidney and is able to survive without dialysis. Should
never be used for patient who has had a kidney transplant. Reported
via the monthly PAR.
Modality
Change - When patient changes type of dialysis (Hemo to CAPD etc.) Reported
via the monthly PAR. NOTE: If patient changes
from in-center hemo to a home modality within 90 days of initial onset of chronic
dialysis a Supplemental 2728 is required.
Change of
Address for patient - No specific form is required for this
event. This information is captured when patients transfer between
facilities via the monthly PAR which now asks for patients current
zip code.
Transplant - This event requires 2728 from transplant facility only if patient
has never been on dialysis, or has had a functioning transplant
for more than 36 months.
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Medical
Evidence Report (2728 Form) -  Download 2728 with "0 - 6 months" choice Here (pdf 6 pgs)
When Is A 2728 Required?
- An Initial 2728 is required when a patient is diagnosed as ESRD and receives their first transplant or outpatient, chronic dialysis treatment(s).
- A Supplemental 2728 form is required when an initial 2728 form has been previously submitted and the patient:
- Transitions to any type of home dialysis within the first 3 months after initial dialysis.
- Has a transplant within the first 3 months after initial dialysis.
- A Re-entitlement 2728 form is required when a patient resumes treatment after benefits have expired; that is, when the patient:
- Restarts dialysis after 1 year or more of having recovered function or discontinued dialysis.
- Restarts dialysis after 3 years or more following a transplant.
- Has another transplant, 3 years or more following a transplant, with no dialysis in between.
How Much Time do we Have to Complete the 2728?
- Network #15 MUST receive the 2728 within 45 days of the patient's starting treatment at your facility (#25 on the 2728.) It is acceptable to FAX the 2728 to NW 15 at 303-860-8392.
Where Can I Get Blank 2728 Forms?
- Obtain more 2728s from your local Social Security office or use this online 2728 (pdf 6 pgs) - but be sure to have the doctor and patient sign this electronically-generated form in BLUE INK. The original signed form goes to Social security and either fax or mail a copy to the Network.
Errors on Paper 2728 Forms Sent to Facilities
- In August 2010 CMS began shipping a supply of blank 2728 and 2746 forms to all ESRD facilities. Unfortunately, the shipped 2728 forms contain errors in two sections.
- The first errors are in boxes 22 and 23. Box 22, which lists dialysis “settings”, contains a second line, "CAPD, CCPD, and Other" that really should appear in box 23 as choices for dialysis “types”.
- Similar errors have been made in boxes 24 and 25. Specifically, the text which should be the second line of box 25 "Dialysis at Current Facility" instead appears in box 24.
- At the present time we do not know if or when CMS will correct these errors. We recommend that you use any correct paper forms you have on hand, and then make copies of this good form (or use this online 2728) until/unless CMS sends correct paper forms. Be sure to have the doctor and patient sign any photocopied versions of the 2728 in BLUE INK. The signed form showing the blue ink goes to Social security and you may fax a copy to the Network.
Race and Ethnicity on the 2728
- Both race and ethnicity must be "self-reported" by patient or patient's family when completing the 2728. If patient is unable to communicate this to the facility, then the staff person completing the form may enter race and ethnicity, but must indicate that they did this in the comments section of the 2728. Please read this NW 15 Memo (pdf- 3 pgs) for further clarification.
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GFR
Calculators
Algorithm for GFR (pdf - 1 pg) - This
summarizes the CMS criteria to determine eligibility for the ESRD
program and should be used when determining the chronic status of
a patient. The GFR value does not need to go on the 2728 form,
but should be calculated to ensure that 2728 forms are submitted
only for truly chronic patients.
Below are additional
resources regarding the basis for the MDRD formula and how to calculate
a GFR using this formula:
www.nkdep.nih.gov/GFR-cal.htm
www.hdcn.com/calcf/gfr.htm
http://nephron.com/mdrd/default.html
www.kidney.org
(K/DOQI Clinical Practice Guideline Tab) - Has downloadable GFR
calculator
and CKD Clinical Action Plan
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Death
Notification Form (2746)
Death
Notification Form (CMS
Form 2746) (pdf
- 2 pgs) - You may download and use this form. DO NOT both MAIL AND FAX the 2746, ONE FAX IS SUFFICIENT.
- Must
be submitted within 30 days of death
- If a patient discontinues dialysis, or goes to a hospital or other acute care setting,
and dies within 30 days, the last chronic dialysis facility is still required to submit a 2746. If patient's last event was a transplant,
the transplant clinic is responsible for submitting 2746.
- Handouts on 2746 compliance
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Forms Compliance
CMS has mandated that at least 90% of all Medical Evidence (Form 2728) and Death Notification (Form 2746) forms turned in to Networks must be both on time and complete (compliant).
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Transplant
Activity Report (TAR)
Each
transplant facility in Network #15 needs to turn in a TAR every
month to report all kidney transplants that have taken place. The
TAR should be faxed to 303-860-8392 and is due by the 10th of the
month. The TAR should NEVER be emailed.
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Network
#15 Reports That are Sent to Dialysis Facilities
Compliance
Reports - (aka: Timeliness and Accuracy Reports) CMS mandates
that 90% of required forms (2746s and 2728s) are submitted on time
and complete. This report shows the percentage of forms received
that meet this standard. Report is sent to facilities semiannually
and is reviewed by CMS to determine if sanctions against facilities
are warranted.
Current
Rejects Report - When the Network receives an incomplete 2728
or 2746 form a Rejects Report is generated. This report lists the
name and SS# of the patient, the type of form that was received
with incomplete information, and an explanation or number of the
field which needs to be completed. Facilities need to return Rejects
Report with the missing info written on it.
Missing
Forms Report - When the Network receives information about patient
events via the PAR without receipt of the corresponding 2728 or
2746 form a Missing Forms Report is generated. Facilities need to
submit the Missing Form immediately.
Quarterly
Roster - Alphabetical list of patients the Network shows to
be currently dialyzing at a facility. Sent out quarterly, the roster
needs to be reviewed by the facility and returned with a list of
any additions or losses. If facility's database has demographic info that conflicts with the roster facility should review the Patient Information Correction Form and mail to Network #15 when applicable.
Tiebreaker
Report - A tiebreaker report is sent out when there is a discrepancy
between the patient data (i.e. patient name, SS#, DOB) we have at
Network #15, and the data from CMS. Please be sure to verify the
"element in question" by looking at original patient
documents, i.e., social security card or Medicare card. Also,
be sure to read any additional information that is included in the
body of the fax that is sent along with the tiebreaker report. Then
return this report to Network #15 ASAP along with a copy of documentation
used to verify correct patient information.
Medicare Reported Deaths - This report is sent out to notify facilities about
death events that have been reported to Network #15 via CMS. Facilities
are NOT required to return or respond to this report UNLESS the
patient is still alive, or had transferred to another licensed,
chronic, Medicare dialysis unit prior to death. In those cases we
ask that you call us at 303-831-8818.
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Definitions
Please see
this complete Glossary
(pdf - 4 pgs) for definitions of frequently
used data terms.
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Frequently
Asked Questions
Q: Is a 2728 still required if a patient dies after only one or two treatments?
A: Yes. If you have a nephrologist that has diagnosed a patient to be chronic, and will sign a 2728 form testifying to this, then you should always complete the 2728 regardless of how long, or short, the patient was on dialysis.
Q: What happens if a patient doesn't sign a 2728 form?
A: If a patient
dies before signing the form, a family member should sign for the
patient. In those rare instances where a signature is impossible
to obtain, facilities should call the Network and ask for Karolyn to explain the circumstances.
Q: When and how should patients on backup hemodialysis be reported?
A: If a patient is expected to be (or ends up) on backup hemo for longer than 30 days they should be considered a transfer in and as such should be reported on the PAR--UNLESS patient is only receiving occasional (2x or less per week) hemodialysis treatments in addition to their PD treatments; in these cases the backup treatments don't need to be reported.
Q:
What happens if a patient enters a long-term care center (i.e. VENCOR)
or a hospital?
A: That
event is now considered an "Interruption in Service" and
should be reported via the Patient Activity Report. That patient is
still considered a part of the population, and any status change
(death, recover function, transfer to chronic facility) needs to
be reported via the PAR. If a patient dies within 30 days of entering an acute facility, the outpatient dialysis unit is still responsible for completing a 2746 form.
Q:
What is the difference between the "Current Rejects Report"
and the "Missing Forms Report"?
A: The
Current Rejects Report is sent when the Network HAS ALREADY RECEIVED
a form, but the form is incomplete. The Missing Forms Report is
sent when the Network has NOT YET RECEIVED a required form (2728
or 2746) to match a patient event.
Q:
Where do facilities obtain blank 2728 and 2746 forms?
A: Local
Social Security offices have blank 2728 forms. The Network has blank
2746 forms, or, better yet, you may download the CMS
Form 2746 here.
Q: Can
facilities fax the 2728 or 2746 forms to the Network?
A: YES, we will accept BOTH forms as faxes. Our fax number is 303-860-8392.
Q: On a 2728 for PD patients should we use the date catheter was inserted as the start date?
A: No. Start date always refers to the date of the first regularly scheduled dialysis treatment.
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2010 Year-End Survey (CMS 2744)
Every facility has now turned in a completed 2744 to Network #15. Copies of the 2744 should be kept on file at your facility for State Health Agencies to review.
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CMS Form 382 - ESRD Beneficiary Selection (Home patients ONLY)
- CMS Form 382 - Network #15 does NOT collect the 382 Form, please do NOT send them to us. We are providing a link to this form as a courtesy only. CMS Form 382 should be sent to your local Part A Intermediary--NOT to Network #15.
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