Frequently Asked Questions (FAQs) for Data

What am I responsible for completing in CROWNWeb?

Please review the EQRS Data Management Guidelines released by CMS.

CMS 2728 - Medical Evidence Report Form

What is the submission date of the CMS 2728 form?
Facilities are urged to submit the 2728 form within 10 days of admission to the first outpatient dialysis facility but have up to 45 days to submit the form in CROWNWeb.

Do the lab values on the Medical Evidence Report (CMS 2728) have to be within 45 days before the Date Regular Dialysis Began (Section B, Item #23)?
Yes, the lab values should be within 45 days BEFORE the Date Regular Dialysis Began, which is the date entered in field #24 on the 2728.


If a patient is not applying for Medicare benefits at the time the 2728 is completed do I still send the form to the local Social Security office?
No, however; keep a copy in the patient's file so that when he/she applies you can send that form to the Social Security office.

How do I obtain a copy of a 2728 form for a patient who has transferred into my facility?
Once a facility transfers a patient into its facility in EQRS it will be able to print a copy of the 2728 form from the system as long as one has been submitted by the originating dialysis facility.

Do I have to complete a 2728 if a patient returns to dialysis after transplant failure?
A facility only needs to fill out another 2728 if a patient returns to dialysis after transplant failure when the transplant functioned for 36 months (3 years) or more.

Do I complete a 2728 for all new starts at my dialysis facility?
A 2728 form should be completed for any newly diagnosed chronic ESRD patient.

What do I do if a patient cannot sign the 2728?
A patient signature is required on all 2728 forms.  If the patient is unable to sign, a family member or someone authorized to act on the patient's behalf should be asked to sign.

On the 2728, Item #2 asks for Health Insurance Claim Number. If a patient does NOT have Medicare, should I list other insurance numbers here?
Only list a Medicare number in this field. If the patient does not have Medicare then you can leave this field blank. Please note : If you write that the patient has Medicare (field #10 on the 2728), you must report the patient's Medicare number in field #2 of the 2728.

CMS 2746 - Death Notification Form

If a patient from an outpatient dialysis center is hospitalized or transfers to a "non-ESRD" provider and dies while in the hospital, who is responsible for completing the CMS 2746 form?
It is the facility's responsibility to complete the 2746 if the patient dies within 30 days. However, if the patient has been gone for more than 30 days from a Medicare facility, then dies while under the care of a non-Medicare provider, this event is classified as a CMS death. With CMS death events, the prior Medicare facility is NOT responsible for completion of the 2746 Death Notification.

If the patient did not have a Health Insurance Claim Number (HIC), do I leave the field blank on the 2746?

Yes, this field should be left blank.

Missing Forms Report

What needs to be done with this report?
The facility should run this report monthly to track their missing and saved CMS 2728 and 2746 forms and submit the forms by the established deadlines.

Acute Patients

What is the definition of an acute patient?
The Network operational definition of an acute patient is someone who has not been diagnosed as chronic end stage renal disease by a physician.
Do I have to submit a 2728 form on an acute patient?
No, 2728 forms should only be submitted for patients that have been diagnosed as a chronic end stage renal disease patient by a physician.


Monthly Caseload Changes/Census Report

What date do I use for a patient starting dialysis for the first time ever on the Monthly Caseload Changes/Census Report?
Use the date the patient was admitted to your facility (#25 on the 2728 form).

What if I have made a mistake or omitted something on the Monthly Caseload Changes/Census Report?

Circle the error and make a correction. At the top of the report, write "revised" or re-fax the report to the network immediately.

Should transient and acute patients be included on the Monthly Caseload Changes/Census Report?
No, the Monthly Caseload Changes/Census Report should only be used for chronic non-transient patient admissions and discharges.