ESRD Network 8 Data Department

Data Management Overview

The Network 8 Data Department has responsibilities for data processing, information management and reporting including the following:

  • To effectively manage the collection, validation, storage, and use of data, including data provided by CMS, for review, profiling, pattern analysis, and sharing appropriate data with CMS and the State survey agency for use in their ESRD Medicare survey and certification activities;
  • To ensure timely and accurate reporting by the facilities;
  • To maintain and ensure the integrity, accuracy, and confidentiality of ESRD patient and facility databases;
  • To ensure the quality and accuracy of the CROWNWeb database for inclusion in the ESRD Program Management and Medical Information System (PMMIS) and the United States Renal Data System (USRDS);
  • To ensure current patient status is reported to CMS in a timely manner for appropriate enrollment and disenrollment into the Medicare program for ESRD benefits;
  • To train facilities in the proper procedures for completing and transmitting forms electronically including establishing facilities’ access to Quality Net Exchange;

Data Collection Forms

Network 8 collects data through the following forms for input into its data management systems:

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FORM 2728 – END STAGE RENAL DISEASE MEDICAL EVIDENCE REPORT | MEDICARE ENTITLEMENT AND/OR PATIENT REGISTRATION

An initial, re-entitlement, or supplemental form is due within 45 days

Form 2728 Categories
Initial For all patients who initially receive a kidney transplant instead of a course of dialysis.
For patients for whom a regular course of dialysis has been prescribed by a physician because they have reached that stage of renal impairment that a kidney transplant or regular course of dialysis is necessary to maintain life. (The first date of a regular course of dialysis is the date this prescription is implemented whether as an inpatient of a hospital, an outpatient in a dialysis center or facility, or a home patient. The form should be completed for all patients in this category even if the patient dies within this time period.)A patient will only have one Initial 2728.
Re-entitlement For beneficiaries who have already been entitled to ESRD Medicare benefits and those benefits were terminated because their coverage stopped 3 years post transplant but now are again applying for Medicare ESRD benefits because they returned to dialysis or received another kidney transplant.

For beneficiaries who stopped dialysis for more than 12 months, have had their Medicare ESRD benefits terminated and now returned to dialysis or received a kidney transplant. These patients will be reapplying for Medicare ESRD benefits.

A patient may have multiple re-entitlement 2728s.

Supplemental Patient has received a transplant or trained for self-care dialysis within the first 3 months of the first date of dialysis and initial form was submitted. A patient will only have one Supplemental 2728, if needed.

Medicare certified dialysis facilities (this does not apply to VHA or transplant facilities) must enter 2728 forms into CROWNWeb. After the form has been completed, a copy must be printed and signed by the patient and physician. An original signed copy (blue ink) needs to be sent to the local Social Security Administration office. For information on how to get a CROWNWeb account go to the QualityNet website and select the ESRD tab.

For facilities that are not required to use CROWNWeb, please download the Form 2728  (opens in a new browser window). It must be submitted to the local Social Security office and a copy must be submitted to the Network within 45 days. Enter the patient’s Zip code into the Social Security Administration Office Locator to determine which Social Security Office to submit the 2728 to. CMS instructions are included with the downloaded form.

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FORM 2746 – END STAGE RENAL DISEASE DEATH NOTIFICATION FORM

For facilities that are not required to use CROWNWeb, please download the Form 2746 (opens in a new browser window). This form must be completed by the facility last responsible for the patient’s maintenance dialysis (or home dialysis) and submitted to the Network within 14 days of the date of death. CMS instructions are included with the downloaded form.

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NETWORK AGREEMENT FORM

Each facility is required to complete a Network agreement form. You can download a copy of the agreement form here.