Completing a CMS-2746 Form in CROWNWeb 12-Apr-17 [Title of the course] Completing a CMS-2746 Form in CROWNWeb Submitting the CMS-2746 Death Notification form in CROWNWeb Whether your facility information was imported from a previous application, or a Network Facility Editor added the facility, one of the first tasks you must perform as a Facility Editor is to update your facility information. www.projectcrownweb.org Copyright © 2004-2009. All rights reserved. Copyright © 2004-2005 NameOfTheOrganization. All rights reserved.

Background Information 12-Apr-17 Background Information [Title of the course] Things to know before you get started: You must submit the CMS-2746 Death Notification form when a patient dies. Only Facility Editors can submit the form. In order to complete the 2746 process: The facility must discharge the patient The facility must provide a reason for death The facility must complete the CMS-2746 form. Note: You can view a workflow of the Completing a 2746 Process in the Appendix of your handout. The first thing you must do is perform a search and select the desired facility. As a Facility Editor, you can see any facilities and their information nationwide, but the only facilities you can edit are the ones that your Network Administrator has granted your scope over. Copyright © 2004-2005 NameOfTheOrganization. All rights reserved.

12-Apr-17 Let’s Take a Look! [Title of the course] 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 first thing you must do is perform a search and select the desired facility. As a Facility Editor, you can see any facilities and their information nationwide, but the only facilities you can edit are the ones that your Network Administrator has granted your scope over. Copyright © 2004-2005 NameOfTheOrganization. All rights reserved.

Discharge the Patient - 1 Search for the patient you wish to discharge, then click Search. CROWNWeb displays the search results. Click the CROWN UPI number of the patient to access the View Patient Attributes screen for that patient.

Discharge the Patient - 2 Click the Admit/Discharge Summary link on the left side of the page. Click the date under the Admit Date column.

Discharge the Patient - 3 On the left side of the screen, click the Edit Admit/Discharge link. Enter the Discharge Date for the patient, and note the Discharge Reason as Death, then click Submit.

Note the Cause of Death - 1 Return to the View Patient Attributes screen for the patient. Click the Edit Patient link on the left side of the page. The Edit Patient attributes screen displays.

Note the Cause of Death - 2 Scroll to the Medical Info section of the form (at the bottom) and specify the Date of Death, the Primary Cause of Death Code or the Primary Cause of Death Description for the patient, and the Effective Date. Click Submit to save the edits and update the death information for the patient.

Complete the 2746 Form - 1 Return to the View Patient Attributes screen for the patient. You will now see an Add 2746 link available on the left side of the screen.

Complete the 2746 Form - 2 Click the Add 2746 link. The Add a New Death Notice (2746) screen displays. Complete the required fields that are missing data.

Complete the 2746 Form - 3 When you have completed the form, click the Submit button. The form is processed by CROWNWeb, and (if no errors or warnings are detected) the View a Death Notice (2746) – Submitted screen displays.

Print for Social Security – 1 Click the Print button at the bottom of the View Medical Evidence Form – Submitted screen. A pop-up window launches containing the completed 2728 form in PDF format.

Print for Social Security - 2 In the upper-left corner of the pop-up window, click the Printer icon to print the form to our default printer. Your Print dialog box will display.

Print for Social Security - 3 Set the print options (if necessary) then click Print. The form will be printed on the printer that you configured. Have the person who completed the form sign the form in blue ink, then submit the form to SSA. Note: Social Security does not accept electronic signatures at this time.

The 2746 Form in CROWNWeb Tip: You can hover over some form items to get more info on that field!

Appendix Alert! In the Appendix section of your handout, you can view a printed version of the CMS-2746 form that is available in CROWNWeb. You can also view a workflow of the process of submitting the form to CMS.

Questions on Form 2746