Q:

I have a patient who returned to dialysis after transplant rejection. Do I need to fill out a CMS-2728 for this patient?

A:    It depends on how long the patient has had the transplant:

*    If the patient has had the transplant for more than 3 years, the ESRD Medicare benefits have been terminated and YES you do need to fill out a new CMS-2728. The lab values need to be 45 days before or after the first dialysis treatment post-transplant failure.

*    If the patient has had the transplant for less than 3 years, NO you do not need to fill out a new CMS-2728.

Q:

I have a patient who started dialysis, then regained kidney function and later restarted dialysis again. Do I need to fill out a CMS-2728?

A:    It depends on how long the patient was off dialysis:

*    If the patient was off dialysis for more than 1 year, the ESRD Medicare benefits have been terminated and YES you do need to complete a new CMS-2728.

*    If the patient was off dialysis for less than 1 year, the ESRD Medicare benefits are still effective and there is NO need to complete a new CMS-2728.

Q:

I have a dialysis patient who is starting dialysis at our facility but is still in Prison. Do I need to fill out a CMS-2728?

A:    It depends if the patient was receiving dialysis prior to starting at your facility:

*    If the patient receives regular course of dialysis for the first time ever, YES you need to complete a new CMS-2728. Make sure to include the prisoner identification code (CDC Code) in the address section.

*    If the patient was receiving dialysis at another facility, NO you do not need to complete a CMS-2728.

Q:

What date do I use for the date a regular course of dialysis began, it is #24 on the 2728 form?

A:    Use the date of the first dialysis treatment after the physician has determined that the patient has ESRD, regardless of where the dialysis treatment was performed (hospital, outpatient facility or home). Acute dialysis treatments received prior to the determination of ESRD do not qualify as date starting a regular course of dialysis.

Q:

A patient started ESRD dialysis at our facility, only had one treatment, and was transferred out to another facility. Am I responsible for making the CMS-2728?

A:    Yes, your facility is still responsible for completing the CMS-2728. List him/her as New ESRD Patient and a transfer-out, even though he/she only received one or two treatments. The other facility will consider him/her as a transfer-in patient.

Q:

I have a dialysis patient who started dialysis in the hospital a few months ago and is coming to our facility today. What date should we put in Field #24 on the CMS-2728? Can we use the hospital labs?

A:    In Field #24 you should to write the date the patient started dialyzing at your facility. The lab dates should not be more than 45 days before or after the first date of regular course of dialysis. You may use the labs taken at your facility.

Q:

We have the patient’s CMS-2728 filled out except for the Doctor’s signature and/or the Patient’s signature, can we still mail in the form? What if we are missing the patient’s signature because he/she transferred out to another facility before signing the form?

A:    No, Network 18 cannot accept CMS-2728 forms with missing signatures. Per CMS we cannot enter the CMS-2728 form in our database. If patient’s signature is missing, please fax the CMS-2728 to the facility where the patient is currently dialyzing so they can have the patient sign.

Q:

I have a patient that will not be applying for Medicare at this time; do I still need to complete the CMS-2728 form? Does the Social Security Office need a copy?

A:    Yes, you need to complete the CMS-2728 form for Medicare entitlement to record the patient in the ESRD registry. You do not need to mail the form to Social Security. Remember to check NO in field #11.

Q:

Do visitors need a 2728?

A     If the patient never received chronic dialysis before, he/she is a new patient not and a 2728 form must be completed. If they are just coming from another facility and staying for less than 30 days, then no, visiting patients who receive regular dialysis at another facility do not need a 2728 form.

Q:

What should I do if the patient can’t sign the form?

A:    Have a guardian sign for them, have the patient make an X and a nurse sign as a witness, or have the patient use a thumbprint. DO NOT send the form without a signature.

Q:

Do patients receiving dialysis on an acute basis need a 2728?

A:    No, only patients who have reached a state of chronic renal failure need a 2728 form.

Q:

If a patient changes their name do I have to complete a new form?

A:    No, just call us and let us know the new name.

Q:

How do I report a patient if they are leaving the United States for a transplant?

A:    You count the patient as a transfer out for a transplant outside the U.S. and state the country in the comment section; it is a 5B on the Patient Activity Report.

Q:

Do I need the Doctor’s signature on the CMS-2746 (Death Notification Form)?

A:    No, we only need the Doctor’s name (print) in Field #15, and the signature of the person filling out the form in Field #16.

Q:

Why is Network sending us Delinquent Notice forms for missing CMS-2746 for patients that we listed as transferred out or discontinued from our facility?

A:    Network 18 receives notifications about expired patients directly from CMS into our database.  We will notify the facility of deaths that occurred less than 30 days from the date the patient left your facility.

Q:

Do I need to do a death form if the patient discontinued dialysis?

A:    Yes, if the patient died within 30 days of discontinuing dialysis.

Q:

What if I don’t know the cause or place of death?

A:    Try to find out from the patient’s doctor. If you still don’t have the information you can put the cause of death as Unknown and the place of death as Other.