Completing the CMS-2746 Form -...

Completing the CMS-2746 Form

Goal: Learn to complete and submit a CMS-2746 Form in CROWNWeb.

Estimated Time: 35 to 40 minutes

Table of Contents

Course Goals .......................................................................................................... 3

Before You Begin ................................................................................................... 4

Note on Older CMS-2746 Forms ............................................................................ 5

Facility Responsibilities .......................................................................................... 6

Part 1 – Edit and Discharge .................................................................................... 7

Edit the Patient’s Record and Discharge the Patient .............................................. 7

Part 1 – Edit and Discharge (continued) ................................................................. 8

Part 2 – Add the CMS-2746 Form ........................................................................... 9

Part 2 – Add the CMS-2746 Form (continued) ..................................................... 10

Print a Saved or Submitted CMS-2746 Form ........................................................ 11

Delete a Saved CMS-2746 Form ........................................................................... 12

Patients That Discontinue Dialysis ....................................................................... 13

Troubleshooting ................................................................................................... 14

Summary ............................................................................................................. 15

Summary (continued) .......................................................................................... 16

Frequently Asked Questions ................................................................................ 17

Demonstration ..................................................................................................... 18

Pop-up Blocker Instructions ................................................................................. 19

Quiz ..................................................................................................................... 20

Completing the CMS-2746 Form Quiz .................................................................. 21

Completing the CMS-2746 Form Quiz (continued) ............................................... 22

Pop-up Blocker Instructions ................................................................................. 23

For More Information .......................................................................................... 24

Quick Start Guides........................................................................................ 24

Online Help .................................................................................................. 24

Field-by-Field Descriptions ........................................................................... 24

Course Goals

By completing this course, you will be able to:

Edit the patient’s record to add a date of death and cause of death.

Discharge a patient with a reason of Death.

Complete and submit the CMS-2746 Form in CROWNWeb.

Locate and view saved CMS-2746 Forms.

Delete saved CMS-2746 Forms.

Before You Begin

Before you can complete this procedure, the following conditions must be met:

The patient must be deceased.

You must know the cause of death.

You must have the role of Facility Editor or Network Patient Editor to add a CMS-2746 Form.

You must have the role of Facility Editor or Network Patient Editor to edit or delete a saved CMS-2746 Form.

Let’s get started!

Note on Older CMS-2746 Forms

When CMS converted data from the old system into CROWNWeb, these older CMS-2746 Forms will be noted when you click on the View 2726 (Submitted) link in the gray sub-menu. The Old 2746 Form Elements window displays only basic information for that CMS-2746 Form. These forms cannot be printed.

Facility Responsibilities

In the 2746 process, facilities have the following responsibilities:

In case of a(n):

Patient Death Submit a CMS-2746 Form within 14 days of being notified of the patient’s death.

Patient Discharge – Discontinues Dialysis

Submit a CMS-2746 Form if the patient dies within 30 days of discontinuing treatment. After 30 days has passed, you are not required to submit a CMS-2746 form.

Acute Patient No CMS-2746 Form is required (since no Initial CMS-2728 Form was submitted).

Part 1 – Edit and Discharge

Upon the death of a patient, you must complete a CMS-2746 Form in CROWNWeb.

The following interactive tutorial will guide you through:

Accessing the patient’s record.

Editing the patient’s record to reflect the patient’s death.

Discharging the patient.

Edit the Patient’s Record and Discharge the Patient

1. Click Patients From the CROWNWeb Home Page, click Patients. The Search for Patients screen displays.

2. Search for Patient Enter search criteria for the deceased patient and click Search. The Patient Search Results screen displays.

3. Click CROWN UPI Click the CROWN UPI of the deceased patient to display the patient’s details. The View Patient Attributes screen displays.

4. Click Edit Patient Click Edit Patient in the gray sub-menu. The Edit Patient Attributes screen displays.

5. Enter Medical Information Scroll down to the Medical Info section to enter:

Date of Death

Cause of Death Code or Description (NOTE: Entering one will auto-populate

the other.)

Click Submit.

Part 1 – Edit and Discharge (continued)

6. Patient Discharged The View Patient Attributes screen displays with the message “Patient Admit Discharge Submitted.” The Discharge Date and Reason of Death display in the Admit/Discharge Summary table.

Part 2 – Add the CMS-2746 Form

After editing and discharging the patient, the facility must add the CMS-2746 Form.

The following interactive tutorial will guide you through adding the CMS-2746 Form in CROWNWeb.

1. Click Add 2746 From the View Patient Attributes screen, click Add 2746 (0) in the gray sub-menu. The Add a New Death Notice (2746) screen displays.

2. Enter Key Patient Info The only required field in this section is Place of Death. Select an option from the drop-down list.

3. Enter Cause(s) of Death

a. Primary Cause of Death – CROWNWeb populates this field from previously entered death information.

b. Were there secondary causes – Select “Yes” if there is a secondary cause. Then select the reason from the drop-down list in the field marked “Select One.” That populates the blank field next to it with the code number.

c. If cause is Other (98), please specify – If you answered “Yes” in field b., then manually enter the “Other” cause of death.

4. Enter Renal Replacement Therapy CROWNWeb requires an entry for (13) Renal Replacement Therapy discontinued prior to death.

If “No,” then CROWNWeb populates (14) Was discontinuation of renal replacement therapy... automatically as Not Applicable.

If “Yes,” the other field entries become mandatory and CROWNWeb requires a selection for (14) Was discontinuation of renal replacement therapy...

Part 2 – Add the CMS-2746 Form (continued)

5. Enter Transplant and Hospice Info If the patient had a previous transplant, enter data in fields: (15) a. Date of most recent transplant; c. Was graft functioning at time of death?; and d. Did transplant patient resume chronic maintenance dialysis prior to death?

Field (16) Was patient receiving Hospice care prior to death? is required.

6. Physician Information In the Physician section, (17) Name of Physician, (18) Person Completing This Form and Date are all required fields.

NOTE: When filling-out the form, click Save to prevent the system from timing-out after 15 minutes of inactivity.

7. Form Information and Click Submit CROWNWeb pre-populates the Form Information section. After completing all sections, click Submit.

8. CMS-2746 Submitted The View a Death Notice (2746) - Submitted screen displays. On the patient attribute screen, the View 2746 (Submitted) link displays in the gray sub-menu.

Print a Saved or Submitted CMS-2746 Form

The following interactive tutorial will guide you through printing a saved or submitted CMS-2746 Form in CROWNWeb.

1. Click Patients From the Home Page, click Patients. The Search for Patients screen displays.

2. Search for Patient Enter your search criteria, and click Search. The Patient Search Results screen displays a list of patients matching your search criteria.

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

4. Click View 2746 (Submitted) For a submitted CMS-2746 Form, click View 2746 (Submitted). The View a Death Notice (2746) - Submitted screen displays.

5. Click Edit 2746 (Saved) For a saved CMS-2746 Form, click Edit 2746 (Saved). The View a Death Notice (2746) - Saved screen displays.

6. Click Print Scroll to the bottom of the screen and click Print. The CMS-2746 Form displays in PDF format.

7. Click Printer Icon Click the Printer icon. The Print dialog box displays.

8. Select Printer Select the desired printer, then click OK.

9. Save Copy Store a copy of the completed, signed form in the patient’s medical records file in accordance with the medical record archival rules in effect in your state.

Delete a Saved CMS-2746 Form

The following interactive tutorial will guide you through deleting a saved CMS-2746 Form in CROWNWeb.

1. Search Patient Enter desired search criteria for the patient. Click Search. The Search for Patients screen displays.

2. Click Search Enter any applicable search criteria for the patient. Click Search. The Patient Search Results screen displays.

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

4. Click Edit 2746 (Saved) Click Edit 2746 (Saved) in the gray sub-menu. The Edit a Death Notice (2746) screen displays the selected CMS-2746 Form.

5. Click Delete Scroll down the screen and click Delete. A confirmation dialog menu displays.

6. Click Yes Click Yes. The View Patient Attributes screen displays. Note: Once you delete a saved CMS-2746 Form, it’s permanently removed from CROWNWeb. Be sure that you really want to remove the form before confirming.

7. Delete Confirmation The View Patient Attributes screen redisplays with the Add 2746 (0) link in the gray sub-menu showing there is no CMS-2746 Form in CROWNWeb for this patient.

Patients That Discontinue Dialysis

If a patient chooses to discontinue dialysis and passes away within 30 days of discharge, you must fill out a CMS-2746 Form for that patient.

1. First, discharge the patient with a reason of Discontinue.

2. Then add the patient’s Date of Death and Cause of Death on the patient’s attributes screen.

3. This triggers the 2746 link in CROWNWeb to add the CMS-2746 Form.

4. Do not change the Discharge Reason from Discontinue to Death.

If the facility discovers the patient has passed away 30 days or more from the date of discontinue, no CMS-2746 Form is required.

Troubleshooting

Commonly experienced problems, recognized solutions, and other key information:

You must enter the Date of Death and Primary Cause of Death in order to view the 2746 link to submit a CMS-2746 Form.

If you cannot edit a CMS-2746 Form, you may not have a Facility Editor role, OR the form may have already been submitted.

If a patient discontinued dialysis and passes away within 30 days from the discharge date, enter the Date of Death and Primary Cause of Death as if the patient were still attached to your facility; then complete a CMS-2746 Form.

If a patient passes away while in a transient status, the home facility is responsible for completing the CMS-2746 Form.

Only saved CMS-2746 Forms can be deleted.

The CMS-2746 Form cannot be edited after submission. You will need to contact the QualityNet Help Desk to make any changes.

Summary

To complete the CMS-2746 Form for a patient, you must:

1. Search for the deceased patient:

From the Homepage, click Patients.

Enter search criteria and click Search.

Click the CROWN UPI for the patient.

2. Add the patient’s date of death and reason:

Click Edit Patient.

Enter Date of Death and Death Code.

Click Submit.

3. Complete the CMS-2746 Form and Submit:

Click Add 2746 (0).

Enter required information; click Submit.

To edit a saved CMS-2746 Form

1. From the Home Page, click Patients.

2. Enter search criteria, click Search.

3. Click the desired patient’s CROWN UPI.

4. To view a saved CMS-2746 Form, click Edit 2746.

5. To edit the CMS-2746 Form, click Edit 2746 (Saved).

6. Apply any desired changes, click Save or Submit.

Summary (continued)

To delete a saved CMS-2746 Form in CROWNWeb:




4. To view a saved CMS-2746 Form, click Edit 2746.

5. Click Delete.

6. Click Yes on the delete confirmation dialog box.

To print a saved or submitted CMS-2746 Form in CROWNWeb:




4. To view a saved CMS-2746 Form, click Edit 2746. To view a submitted CMS-2746 Form, click View 2746 (Submitted).

5. Click Print.

6. Print the form by clicking the Printer icon or press Ctrl + P.

7. Select the desired printer, then click OK.

8. Store a copy of the completed, signed form in the patient’s medical records based on your state’s medical record archival rules.

Frequently Asked Questions

To view Frequently Asked Questions for this topic, click the following link:

ACCESS FAQs

Enter the words “2746” (or any other applicable keyword) to view FAQ content for that topic.

http://www.projectcrownweb.org/assets/FAQs/index.html

Demonstration

The Completing the CMS-2746 Form demonstration will allow you to either view the process or interact with a mock version of CROWNWeb to simulate the experience of completing a CMS-2746 Form in the system.

Click the View Demonstration button below to view the demonstration; or

Click the Bypass Demonstration button to skip the demonstration and advance to the Completing the CMS-2746 Form Quiz.

View Demonstration

Bypass Demonstration – To Quiz

Help on Pop-up Blocker

Pop-up Blocker Instructions

To turn off pop-up blocker for your web browser when you get the “Pop-up blocked.” message…

Go to the top menu bar and select:

Tools > Pop-up Blocker > Always Allow Pop-ups from This Site…

Return to Demonstration

Quiz

The Completing the CMS-2746 Form Quiz will test your knowledge on completing a CMS-2746 form in CROWNWeb.

Click the Take Quiz button below to take the Completing the CMS-2746 Form Quiz; or

Click the Bypass Quiz button to skip the quiz and advance to the end of the tutorial.

Take Quiz

Bypass Quiz – End Tutorial

Help on Pop-up Blocker

Completing the CMS-2746 Form Quiz

1. If a patient passes away while in Transient status, who completes the CMS-2746 Form? [select one]

A. Home facility B. Current facility C. The Network

Answer: A. Home facility

2. What can you do with saved CMS-2746 Forms? A. They can be edited. B. They can be submitted. C. They can be deleted. D. They can be printed. E. All of the above.

Answer: E. All of the above

3. Facilities can only _______ a CMS-2746 Form after it has been submitted. A. Delete B. Save C. Print D. Edit

Answer: C. Print

4. A CMS-2746 Form is used to notify CMS that the patient has had a transplant.

True/False Answer: False

Completing the CMS-2746 Form Quiz (continued)

5. The CMS-2746 must be submitted within ____ days of the patient’s death. [Move correct answer to blank bubble]

A. 90 B. 60 C. 30 D. 45

Answer: C. 30 days

6. If a patient discontinues dialysis and passes away within 30 days, you must fill out a CMS-2746 Form for the patient.

True / False

Answer: True. You must fill out a CMS-2746 Form when a patient discontinues dialysis and passes away within 30 days.

7. Who signs the CMS-2746 Form? [select one] A. Facility Editor B. Person completing the form in CROWNWeb C. Facility Administrator D. Network Patient Editor

Answer: B. Person completing the form in CROWNWeb

FINISH TUTORIAL

Pop-up Blocker Instructions

To turn off pop-up blocker for your web browser when you get the “Pop-up blocked.” message…

Go to the top menu bar and select:

Tools > Pop-up Blocker > Always Allow Pop-ups from This Site…

Return to Quiz

For More Information

Quick Start Guides

The CROWNWeb Quick Start Guides provide short and simple instructions on tasks users can perform in CROWNWeb, including completing a CMS-2746 Form.

Click the link below to access the CROWNWeb Quick Start Guides.

GO TO QUICK START GUIDES

Online Help

The CROWNWeb Online Help is a resource that contains instruction on all facets of the CROWNWeb system, including completing a CMS-2746 form.

Click the link below to access the CROWNWeb Online Help.

GO TO ONLINE HELP

Field-by-Field Descriptions

The CROWNWeb Field-by-Field Descriptions are an online resource that contains details on every field on screens in the CROWNWeb system.

Click the link below to access the CMS-2746 Form Field-by-Field Descriptions.

GO TO FIELD DESCRIPTIONS

Thank you for taking this tutorial!

This material was prepared by FMQAI, the CROWNWeb Outreach, Communication, and Training contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

COCT contract # HHSM-500-2011-00157G.

Publication Number: FL-OCT-2012OTCT32-4-12855

http://www.projectcrownweb.org/crown/index.php?page=CROWNWeb_Training&subPage=Quick_Start_Guide

http://www.projectcrownweb.org/assets/crownweb/index.htm

http://www.projectcrownweb.org/assets/simulations/tables/Patients/index.htm

Completing the CMS-2746 Form -...

Documents

Transcript of Completing the CMS-2746 Form -...