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Submitting CMS-2728 forms using the CROWNWeb system Completing a CMS-2728 Form in CROWNWeb www.projectcrownweb.org Copyright © 2004-2009. All rights reserved.

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Presentation on theme: "Submitting CMS-2728 forms using the CROWNWeb system Completing a CMS-2728 Form in CROWNWeb www.projectcrownweb.org Copyright © 2004-2009. All rights reserved."— Presentation transcript:

1 Submitting CMS-2728 forms using the CROWNWeb system Completing a CMS-2728 Form in CROWNWeb Copyright © All rights reserved.

2 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 Note: You can view a workflow of the Completing a 2728 Process in the Appendix of your handout.

3 Let’s Take a Look! Let’s take a look at how we’ll admit and discharge patients in CROWNWeb! LiveLive (link to CROWNWeb Application) Next Slide Next Slide (continue PPT) Questions?

4 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 The Manage 2728 screen displays. 5.Click the Add 2728 button. The Add a 2728 screen displays.

5 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.

6 CROWN UPI Number 3.Click the CROWN UPI Number hyperlink for the desired patient. The View Patient Attributes screen displays.

7 Adding a 2728 for the Patient 4.On the View Patient Attributes screen, click The Manage 2728 screen displays. 5.Click the Add 2728 button. The Add a 2728 screen displays.

8 The 2728 Form in CROWNWeb Tip: You can hover over some form items to get more info on that field!

9 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.

10 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.

11 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. Print the 2728 Form

12 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. Submit the 2728 Form

13 Supplemental and Re- Entitlement 2728 Forms What are they, and how to use them in CROWNWeb

14 Supplemental and Re-entitlement 2728s Supplemental/Re-entitlement 2728s Steps are identical to completing an Initial Circumstances where required depend on the patient’s course of treatment.

15 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.

16 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.

17 Click on the Add 2728 button. The View ESRD Medical Evidence (2728) screen displays. Re-entitlement 2728

18 Re-entitlement 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.

19 Troubleshooting 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 If you’re having difficulty completing the 2728 form, the following tips might help you out:

20 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

21 Questions on the 2728 Form


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