Information regarding changes to 2746 form
Modified on: Thu, Sep 10, 2020 at 10:54 AM
This message is being provided on behalf of the Centers for Medicare & Medicaid Services (CMS) and the Division of Kidney Health (DKH).
The purpose of this announcement is to provide clarification related to Form CMS-2728 End-Stage Renal Disease (ESRD) Medical Evidence Report Medicare Entitlement and/or Patient Registration Form and Form CMS-2746 Death Notification Form.
In November 2019, the Office of Management and Budget (OMB) approved revisions to CMS-2728 and CMS-2746. At this time, those revisions are not yet reflected in CROWNWeb; however, the most current forms will be made available with the planned implementation of the updated ESRD Quality Reporting System (EQRS). In the interim, CMS will continue to accept both versions of the forms.
If you have any questions regarding this announcement, please email the ESRD National Coordinating Center at firstname.lastname@example.org with the subject line: CMS-2728/CMS-2746.
Please see tutorial below on how to submit 2728 form.
Please note under patient information instead of Social Security Number, Medicare Claim Number / Beneficiary Identifier
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