Transcript CMS Form Compliance Report To Facilities

CMS Form Compliance Report
To Facilities
How to Interpret the Data
CMS Form Compliance Report
to Facilities
The CMS Form Compliance Report to
Facilities collects information from
dialysis facilities and compiles data to
include a facility compliance rate section
that includes the number of forms
received, timeliness rate, number of
forms on time, accuracy rate upon initial
receipt of form, number of accurate
forms, and average overall compliance
rate.
CMS Form Compliance Report
to Facilities
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The time period that this report covers
is listed immediately after the title of
the report
Your provider number, faccode and
facility name will appear next
CMS Form Compliance Report
to Facilities
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Next you will see the following columns
by form type
Patient Name = Last name, first name
SSN or HIC = Patient’s SSN will appear
here unless they have a Medicare
number
CMS Form Compliance Report
to Facilities
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Event Date = date patient started dialysis at
your facility from the 2728 form or the date
the patient died from the 2746 form
Received by Network = date the Network
received the form
The 2728 is due to the Network within 45
days of the patient starting dialysis at your
facility and the 2746 is due within 30 days of
the date of death
CMS Form Compliance Report
to Facilities
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Returned to Facility = date the form
was marked as inaccurate due to
erroneous or missing information
Completed form Rec’d = date Network
obtained corrected or missing
information via telephone call to facility
CMS Form Compliance Report
to Facilities
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Error – Field Numbers = reflects fields
from 2728 and 2746 containing errors
or missing information and “Late”
indicator for forms received outside of
guidelines
CMS Form Compliance Report
to Facilities
Compliance for This Time Period
This section is a summary of what was
reflected in detail by form type above it.
CMS Form Compliance Report
to Facilities
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Type = form type, State numbers and
Network numbers
Total Rec’d = total forms received by
type, State and Network totals
CMS Form Compliance Report
to Facilities
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% (#) On Time = timeliness rate and
the number of forms submitted on time
by type
Example: Total Rec’d = 9; # on time =
6; 6 divided by 9 = 66.7% timeliness
rate
CMS Form Compliance Report
to Facilities
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% (#) Accurate = accuracy rate and the
number of forms submitted that were
complete and without errors by type
Example: Total Rec’d = 9; # accurate =
9; 9 divided 9 = 100% accuracy rate
CMS Form Compliance Report
to Facilities
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Combined Compliance Rate =
timeliness rate plus the accuracy rate
divided by 2 for the provider, State and
Network
Example: 66.7% + 100.0% / 2 =
83.3%
CMS Form Compliance Report
to Facilities
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Provider Total = total of all categories
with the same calculations
The Combined Compliance Rate for the
Provider Total is the rate that is
compared to the CMS goal of 90.0%