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Network Data Reporting for Dialysis Facilities and Transplant Centers

Forms and Reports. CMS-2728CMS-2746CMS-2744Monthly Patient Activity ReportQuarterly Census Verification. CMS-2728. END STAGE RENAL DISEASE MEDICAL EVIDENCE REPORTMEDICARE ENTITLEMENT AND/OR PATIENT REGISTRATION. This form MUST BE completed within 45 days for ALL the following:. Patients who start a regular course of dialysis for the first time ever Patients who initially receive a kidney transplant instead of a course of dialysis Patients 3 or more years post transplant who return to 1145

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Network Data Reporting for Dialysis Facilities and Transplant Centers

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    1. Network Data Reporting for Dialysis Facilities and Transplant Centers

    2. Forms and Reports CMS-2728 CMS-2746 CMS-2744 Monthly Patient Activity Report Quarterly Census Verification

    3. CMS-2728

    12. CMS-2746 ESRD DEATH NOTIFICATION

    17. CMS-2744 Annual Facility Survey Year end summary Network mails form to each facility along with yearly events report and ending patient census Facility makes necessary corrections using the events and census reports Facility completes remaining items on form Form is returned to Network by due date Network completes data entry and sends to CMS

    18. CMS-2744 How To Prepare Verify the data in each quarterly report to ensure an accurate year end census Develop a method for tracking yearly treatment totals. Check with billing department. Keep a list of patients referred to Vocational Rehabilitation during the year Report your data accurately and timely to the Network throughout the year

    19. Monthly Patient Activity Reports List of patient events during the month Due by 10th of the following month Provider number and name and month/year reported must all be on the form Fill in all necessary information for each event Type or print neatly to avoid processing delays No acute or transient patients Transfer outs – include where they went

    20. Monthly Patient Activity Reports When reporting a New ESRD Patient event please send the 2728 form When reporting a Death event please send the 2746 form If you have events to report for the month, write “No Activity” on the report and fax it in.

    21. Quarterly Reports Network mails reports to each facility Patient events during the quarter Patient census at end of quarter Verify the data in each report and make corrections as needed Return updated reports to the Network by the due date

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