Information Management & Data Services
Network 4 collects, validates, analyzes, and reports on a number of activities for CMS as it maintains a national registry of renal information. The data that the Network maintains includes, but is not limited to: the identification of dialysis and transplant units, ESRD Medical Evidence/Medicare Entitlement, regional demographic statistics, as well as the support on all quality initiatives.
The Network uses the Standard Information Management System (SIMS) as the repository of all its data efforts. The completion of all Network data collection tools and CMS Forms is critical to our program. Reports and quality improvement initiatives rely on the information found in SIMS. All Medicare certified dialysis providers, Medicare certified renal transplant centers and Department of Veterans Affairs units are required to participate in our data collection and other activities.
We also strive to provide the ESRD community with useful information in a clear and easy to understand format. This page is dedicated to share data collection forms, data reports, instructions and helpful tips that come from our Data Services Department.
Information Management Data Manual
Network 4 developed this Data Manual (format: PDF, size: 189 kb) to assist Medicare-approved facilities and their staff in completing both the Centers for Medicare & Medicaid Services (CMS) and Network 4 required data collection forms.
Current Dialysis Unit Directory
Looking for a listing of dialysis units in Pennsylvania and Delaware? Download our current Dialysis Unit Directory (format: PDF, size: 185 kb). It contains the name, address and phone number for each dialysis unit in Pennsylvania and Delaware.
Monthly Patient Activity Reports (mPAR)
A Monthly Patient Activity Report is due to the Network office on the 10th day of each month for the prior month's activity. Even if your unit had no patient activity during that timeframe, we would still like you to return a form to the Network office.
- Blank Monthly Patient Activity Report (format: PDF, size: 52 kb)
- mPAR Form Instructions (format: PDF, size: 102 kb)
- Standard Event Definitions and Business Rules (format: PDF, size: 114 kb)
Patient Population Report
Periodically, we will post our Patient Population Report (format: PDF, size: 126 kb, effective: 07/31/2007). This report provides a snapshot of our dialysis patient population as of a point in time, with breakdowns by state, county name, and zip code by modalities (in-center hemodialysis, CAPD, CCPD and home hemo). Please note, however, that due to CMS guidelines, we mask the total number of individuals residing in any zipcode where the total count is less than 11 (but, the county and state totals reflect the actual numbers). If you need more current, or different, time period data, please contact the Network office.
CMS-Forms
In support of the ESRD program with the Centers for Medicare & Medicaid Services, the Data Department of Network 4 processes the following forms:
- CMS-2728 (format: PDF, size: 198 kb) -- End Stage Renal Disease Medical Evidence Report; Medicare Entitlement and/or Patient Registration
- CMS-2746 (format: PDF, size: 90 kb) -- ESRD Death Notification
- CMS-2744A (format: PDF, size: 412 kb) -- ESRD Facility Survey (DIALYSIS UNIT ONLY)
- CMS-2744B (format: PDF, size: 396 kb) -- ESRD Facility Survey (TRANSPLANT UNIT ONLY)
- CMS-820 (format: PDF, size: 72 kb) -- In-Center Hemodialysis CPM Form
- CMS-821 (format: PDF, size: 56 kb) -- Peritoneal Dialysis CPM Form
During Emergencies, Keeping the Network Informed is Critical
You should notify the Network office if you are providing dialysis services to an individual that has been evacuated due to a natural disaster or other emergency. The Network tracks where patients are receiving services for the purposes of facilitating the exchange of critical patient and treatment information, identifing where additional dialysis access is needed, and devising plans for re-entry into the affected areas.
If the patient is being seen at a facility affiliated with a large dialysis corporation, please follow that organization's plan for notification. The large dialysis organization will be providing this information to the ESRD Networks in a centralized manner. If the patient is being seen at an independent facility, please notify the Network 4 directly. When you contact the ESRD Network, you will be asked to provide only the information that is needed to help treat and track the patient. The ESRD Networks will be sharing this information with the Red Cross in order to assist in the location of individuals. Because of the critical condition of patients in need of dialysis, many of these patients are moving across the Country, treatment-by-treatment, and have lost touch with family members.
You can obtain a complete listing of contact information for the ESRD Networks at http://www.esrdnetworks.org. Under emergency situations, such as Hurricane Katrina, the HIPAA Privacy Rule allows covered entities to share patient information to assist in disaster relief efforts and to assist patients in receiving the care they need. This information is in a Special Bulletin, which you can readily access from the "What's New" column on the OCR website, http://www.hhs.gov/ocr/hipaa, by clicking on "Hurricane Katrina Bulletin: Disclosing PHI in Emergency Situations."
If your facility is treating or providing care for a patient with end-stage renal disease within the states of Pennsylvania or Delaware who has been displaced as a result of an emergency situation, evacuation, or natural disaster, please complete and fax back the Displaced Patients Data Collection Form (format=PDF, size=56 kb) to the ESRD Network 4 Office by 1:00 PM EDT on the date that the patient is known to you.
Consolidated Renal Operations in a Web-enabled Network (CROWN)
CROWN is being implemented to improve the quality of ESRD information, to reduce the inconsistency of ESRD data, to reduce the complexity of ESRD systems, to replace outdated, unsupported technology, and to support electronic data collection at the information source, in a secure, integrated environment.
CMS and the ESRD Networks are working together to build this integrated ESRD information system to facilitate the collection and maintenance of information about the Medicare ESRD program, its beneficiaries and the services provided to them.
CROWN implementation began in June 2002 and it includes:
- The Vital Information System to Improve Outcomes in Nephrology (VISION), which supports electronic data entry and encrypted transmission of ESRD patient data from dialysis facilities directly to their Networks via a secure, Web-enabled environment called "QualityNet Exchange"
- QualityNet Exchange is the CMS-approved authority on transmitting the ESRD patient data between facilities and the Networks
- The ESRD Standard Information Management System (SIMS). This software application supports the business processes of the ESRD Network Organizations, and provides data exchange among the Networks
- The Renal Management Information System (REMIS), which replaced CMS's Renal Beneficiary and Utilization System (REBUS), determines the Medicare coverage periods for ESRD patients and serves as the primary mechanism to store and access ESRD patient and facility information in the ESRD Program Management and Medical Information System Database
The Network created a brochure (format: PDF, size: 176 kb) that is used to market and support the CROWN environment.
Currently, Network 4 and our units are actively involved in the testing of "CROWN Web": a zero footprint web-based application that will be replacing VISION, SIMS and QualityNet Exchange. If you are a unit interested in testing "CROWN Web", please contact the Network office.
Technical Assistance Available
ESRD Network 4 is happy to provide the following services ...
- Provide education and clarification for the completion of CMS Forms (2728, 2746, 2744, Patient Activity Report)
- Supply facilities with 2746 and/or 2728 forms upon request
- Educate and assist faciliites regarding reports sent from the Network (Quality Roster Report, Compliance Report, etc.)
- Assist with the devlopment of action plans to improve forms completion processes
- Process data requests from facilities, and Medicare Advantage insurance providers
- Provide education and assistance regarding CMS requirements
- Communicate essential information that will affect facilities via mail, e-bulletin, or fax
- Represent the needs of the renal community, patients and providers to CMS
- Develop collaborative partnerships to promote improved quality outcomes for patients
- Inform facilities about Network goals and activities
