Get Cms Cms-2746-u2 2018-2025

Filling out the CMS CMS-2746-U2 form online can be a straightforward process if you follow the steps outlined in this guide. This form, known as the ESRD Death Notification, is essential for reporting details related to the death of patients with end-stage renal disease.

Follow the steps to complete the CMS CMS-2746-U2 online form.

1. Click ‘Get Form’ button to access the CMS CMS-2746-U2 and open it for completion.
2. Enter the patient’s last name, first name, and middle initial as they appear on the Medicare card.
3. Indicate the patient’s sex by checking the appropriate box.
4. Input the patient's date of birth in the format of month, day, and year using an 8-digit number (e.g., 07/24/2000).
5. Enter the patient’s Medicare Beneficiary Identifier or, if unavailable, their Social Security Number as it appears on the appropriate card.
6. Provide the patient’s state of residence using the two-letter postal abbreviation (e.g., MD for Maryland).
7. Select the place of death by checking the corresponding box indicating the location (e.g., hospital, home, etc.).
8. Enter the date of death using the 8-digit number format.
9. Choose the modality at the time of death from the provided options and check the appropriate box.
10. Fill in the complete name and address of the provider submitting the form.
11. Input the 6-digit Medicare provider number associated with the provider.
12. List the causes of death: Enter the numeric code for the primary cause and check whether there were secondary causes. Specify if 'other' (code 98) is selected.
13. Indicate whether renal replacement therapy was discontinued prior to death, and specify the conditions if applicable.
14. Answer questions related to if the deceased ever received a transplant, and provide corresponding details if so.
15. Confirm whether the patient was receiving hospice care prior to death by selecting the appropriate response.
16. Print the name of the physician providing the information for the form.
17. Complete the form with the signature of the person filling it out, along with the date.
18. Finally, save the form changes, download it, print a hard copy, or share it with the appropriate ESRD Network, if necessary.

Start filling out the CMS CMS-2746-U2 form online today to efficiently manage the paperwork.