CROWNWeb

 

 

Add a CMS-2746 Form

 

A CMS-2746 form (End Stage Renal Disease Death Notification) is completed by providers to notify Medicare of the death of an End Stage Renal Disease (ESRD) patient, including the date and cause of death.  The Federal Government requires the reporting of all deaths of ESRD patients. Centers for Medicare & Medicaid Services (CMS) databases are updated with this information to provide survival statistics.

Note: The CMS-2746 for a patient must be submitted within 14 days after the patient’s date of death.

The Add 2746 (0) link in the navigation bar of the View Patient Attributes screen indicates that a user can add a 2746 for this patient.

Note: Before creating a CMS-2746, a user must make sure that the Date of Death and the Primary Cause of Death fields have been entered on the Patient Attributes screen.

To complete a CMS-2746 form:

  1. From the Home screen, click the Patients link. The Search for Patients screen displays.
    Click here to view image
  2. Enter the patient criteria, and then click Search The Patient Search Results screen displays.
    Click here to view image
  3. Click the desired patient's CROWN UPI link. The View Patient Attributes screen displays.
    Click here to view image
  4. Click the Edit Patient link. The Edit Patient Attributes screen displays.
    Click here to view image
  5. Scroll down and enter the Date of Death and Death Code in the Medical Info section, and then click Submit. The View Patient Attributes screen displays the message View Patient Details Submitted.
    Click here to view image
  6. Click the Add 2746 (0) link. The Add a New Death Notice (2746) screen displays with pre-populated information from the current patient record.
    Click here to view image
  7. Enter the available data and then clickSubmit.
    Click here to view image
  8. The form is not considered complete until it has been submitted.
    Click here to view image









© 2018 Centers for Medicare and Medicaid Services