Transcript Edit Facility Information - Welcome TO ESRD NETWORK 13

Completing a
CMS-2728 Form in
CROWNWeb
Submitting CMS-2728 forms
using the CROWNWeb system
www.projectcrownweb.org
Copyright © 2004-2009. All
rights reserved.
Background Information
Things to know before you get started:
• 2728 is required for all dialysis patients that will
be submitted for reimbursement through
Medicare.
• Must admit patient before you can complete a
2728 form.
• Only a Facility Editor can add a 2728.
Note: You can view a workflow of the
Completing a 2728 Process in the Appendix
of your handout.
Let’s Take a Look!
Let’s take a look at how we’ll admit and
discharge patients in CROWNWeb!
Live (link to CROWNWeb Application)
Next Slide (continue PPT)
Questions?
The Procedure
1. From the CROWNWeb home page, select Patients.
The Search for Patients screen displays.
2. Enter search criteria to find the desired patient and click
Search. The Search Results screen displays.
3. Click the CROWN UPI Number hyperlink for the
desired patient. The View Patient Attributes screen
displays.
4. On the View Patient Attributes screen, click 2728.
The Manage 2728 screen displays.
5. Click the Add 2728 button.
The Add a 2728 screen displays.
Searching for Patients
1. From the CROWNWeb home page, select Patients.
The Search for Patients screen displays.
2. Enter search criteria to find the desired patient and click
Search. The Patient Search Results screen displays.
CROWN UPI Number
3. Click the CROWN UPI Number hyperlink for the
desired patient. The View Patient Attributes screen
displays.
Adding a 2728 for the Patient
4. On the View Patient Attributes screen, click 2728.
The Manage 2728 screen displays.
5. Click the Add 2728 button.
The Add a 2728 screen displays.
The 2728 Form in CROWNWeb
Tip: You can hover over some form items to get more info on that field!
Saving Incomplete 2728s
You can save incomplete forms to complete later.
Click Save. The View ESRD Medical Evidence Submitted
screen displays.
Note: A saved 2728 form can be modified – submitted forms
cannot.
Deleting Saved 2728s
1. Click the 2728 Link
2. Open the saved 2728 form
3. Click the Edit 2728 link to open the saved
2728 form for editing (and deleting).
4. Scroll to the bottom of the page and click the
Delete button.
5. Click Yes on the confirmation box that appears
to confirm.
Print the 2728 Form
Before submitting a saved 2728, you need to print copies and
obtain patient and physician signatures (in blue ink). Social
Security requires that these signed forms be sent in by mail.
To print the completed 2728, open the saved 2728 and click Print.
The form displays in PDF format, allowing you to print for
signatures.
Submit the 2728 Form
Once you obtain physician and patient signatures, you are ready
to Submit the form to CROWNWeb
Open the saved form, then click the Submit button at the bottom of
the page. The form will be submitted for processing.
Note: You can no longer delete the 2728 from the patient’s
record once you submit it.
Supplemental and ReEntitlement 2728 Forms
What are they, and how to use them in
CROWNWeb
Supplemental and Re-entitlement 2728s
Supplemental/Re-entitlement 2728s
• Steps are identical to completing an
Initial 2728.
• Circumstances where required depend
on the patient’s course of treatment.
Supplemental 2728 – About
Required when:
• an initial 2728 has been previously submitted and
• a patient transitions to self care dialysis or
• a patient has a transplant within the first 3 months after
initial dialysis.
When modality changes (Hemodialysis to home dialysis or the
patient receives a transplant), change the modality, return to
the patient page, and
select the 2728 button.
The Add an ESRD
Medical Evidence (2728)
screen displays.
Supplemental 2728
The Supplemental 2728 will be grayed out in the areas that are
not affected by the change in modality.
1.Complete the Section C for Transplant and Section D for
Training (Change in Modality) and click Submit.
Re-entitlement 2728
Click on the Add 2728 button. The View ESRD Medical Evidence
(2728) screen displays.
Re-entitlement 2728 - Access
Required when a patient resumes treatment after benefits have
terminated.
1. Complete the admission process for the patient, proceed to the
View Patient Attribute screen, and click on the 2728 link.
Troubleshooting
If you’re having difficulty completing the 2728 form, the
following tips might help you out:
• Ensure that the 2728 mandatory
fields are completed on the Patient
Attribute Page before creating a
2728 to prevent having to navigate
back and forth between the pages.
• Ensure that the Reason for
Admission for a new patient is “ New
to ESRD” to complete a 2728.
Appendix Alert!
In the Appendix section of your handout, you can view a
printed version of the CMS-2728
form that is
available
in CROWNWeb
Questions on the 2728 Form