Network Patient Activity Report Instructions
revised: 05/26/2005
Requirements
Centers for Medicare & Medicaid Services (CMS)
requires ESRD Networks to track Patient activity throughout the year, including
additions, losses, or neutral events.
All CHRONIC Patients should be included in the report regardless of
modality.
A Network Patient
Activity Report (NPAR) must be completed at the end of each month and submitted
by the 10th day of the following month.
Please keep a copy of the completed NPAR for your records then return
the original via mail or Quality Net Exchange.
Blank NPARs may be obtained from your Network office.
Notes:
* The NPAR does not
replace CMS forms 2728 and 2746. You
must submit a CMS-2728 form for every new ESRD Patient and a CMS-2746 form for
every death event.
*The NPAR should not include the names of transient
patients. A transient patient is one
who arrives at your facility from another outpatient unit and dialyzes for less
than 30 days with no intent to be permanent.
* (Optional)
The beginning and ending census may be calculated for the submitting period
using the additions and loss totals.
Neutral events, including Modality Changes, do not affect the ending
census population.
How to Complete the NPAR
1.
Enter your Provider Number (the Medicare
number assigned to you by CMS).
2.
Enter your Provider
Name (the name of your facility).
3.
Enter the Reporting
Month (the month in which all activities occurred).
4.
Enter your facility’s
telephone number.
5.
Print your name on the form.
6.
Enter the patient’s
Last Name.
7.
Enter the patient’s
First Name.
8.
Enter the patient’s
Social Security Number.
9.
Enter the patient’s
Date of Birth.
10. Enter the patient’s Gender.
11. Enter the patient’s ZIP Code
12. Enter the date the event occurred
and the type of patient Addition, Loss, or Neutral event. If this is an
addition, include the Patient’s most current modality. For
Patients who are In-Center Frequent Dialysis or Frequent Home Hemo (5 or more
times per week), write the number of sessions per week in parentheses next to
the modality code. Neutral events are
not considered additions or losses and do not change your facility’s overall
population.
13.
Enter the Provider Number or Name and State (or country) of
the Sending/Receiving Facility.
Additions
1
= New ESRD Patient—Patient has been diagnosed as ESRD and receives
his/her first-ever outpatient, chronic dialysis treatment. A CMS-2728 form must be submitted for all
new ESRD Patients.
2A = Transfer In, Category A—Patient
transfers into dialysis facility on a permanent basis having previously
dialyzed at an ESRD-Medicare Certified Provider.
2B = Transfer In, Category B—Patient
transfers into dialysis facility on a permanent basis having previously
dialyzed chronically in another country or in prison. This will be the
Patient’s first outpatient, chronic dialysis at an ESRD-Medicare Certified
Provider. A CMS-2728 form must be
submitted for all Category B Patients. List the country patient is transferring
in from in the comment field.
3
= Restart—Patient previously stopped dialysis treatment and is now
resuming long-term, outpatient dialysis. This does not include patients
returning to dialysis after transplant.
4A
= Dialysis After Transplant Failed in US—Patient has rejected a
transplant received at a Transplant Hospital within the US and is receiving
his/her first post-transplant, outpatient dialysis.
4B = Dialysis
After Transplant Failed outside of US—Patient has rejected a transplant
received at a Transplant Hospital outside of the US and is receiving his/her
first post-transplant, outpatient dialysis.
Losses
5A
= Transfer Out for Transplant within US—Patient leaves dialysis facility
to receive a kidney transplant at a Transplant Hospital inside the US. Include the provider number or name and
state of transplant center.
5B= Transfer
Out for Transplant outside of US—Patient leaves dialysis facility
to receive a kidney transplant at a Transplant Hospital outside of the US.
Include the country the patient is transferring to for transplant in
the comment field.
6A = Transfer Out, Category A—Patient
transfers long term/permanently to an ESRD-Medicare Certified Dialysis
Provider.
6B = Transfer Out, Category B—Patient
leaves facility and will be receiving long-term dialysis (greater than 30 days)
in prison or in another country.
6C = Transfer Out, Category C—Patient has
been discharged from facility against his/her will. Use this event for all involuntary discharges, regardless of where
pPatient will receive services after
discharge.
7
= Discontinue— Patient stops dialyzing after the decision to permanently
stop dialysis has been specifically articulated.
8
= Death—Patient died. A
CMS-2746 form must be submitted for all death events.
9
= Recover Function—Patient regains renal function of his/her native
kidney and is able to survive without ESRD therapy.
10
= Lost to Follow Up—Patient stopped attending dialysis and his/her
whereabouts are unknown. Facility should make every effort to locate the
Patient. This event should rarely be used.
Neutral Events
(These
events do not change facility population)
11 = Modality Change—Patient remains at the treatment
facility and changes his/her anticipated long-term dialysis modality. For Patients who are In-Center Frequent
Dialysis or Frequent Home Hemo (5 or more times per week), write the number of
sessions per week in parentheses next to the modality code.
15
= Interruption in Service—Patient is receiving long-term dialysis (greater than
30 days) at an acute care setting or rehabilitation facility, and is expected
to return to the outpatient dialysis facility.
16 = Resume Service—Patient returns to the outpatient
dialysis facility from an acute care setting or rehabilitation facility.
Dialysis Modality
Method of treatment for kidney failure/ESRD: Modality types include hemodialysis and
peritoneal dialysis.
|
InCenter
Hemodialysis |
A method of dialysis
in which blood from a patient’s body is circulated through an external device
or machine and then returned to the patient’s blood stream. Patient is receiving hemodialysis usually
three times a week on an outpatient basis and treatment lasts 3 to 4 hours. |
|
Home Hemodialysis |
Hemodialysis is done
at home by the patient and a partner. Both are trained in the dialysis
facility until the patient and partner become proficient to dialyze at
home. The dialysis is usually three
times per week. |
|
Home Assisted Hemo |
Hemodialysis is done
in a home setting through a staff-assisted program. Patient is not trained to do dialysis himself. |
|
InCenter –Self
Dialysis |
Dialysis is
performed with little or no staff assistance by an ESRD patient who has
completed an appropriate course of training. |
|
Frequent Dialysis -
InCenter |
Patients who are
prescribed to have hemodialysis in the outpatient dialysis facility 5 or more
times per week and the hours of treatment may vary according to the patients’
need. |
|
Frequent
Dialysis - Home Hemo |
Patients who are
prescribed 5 or more days of dialysis treatment at home. The number of hours per treatment may vary
according to the patient need. |
|
Continuous
Ambulatory Peritoneal Dialysis (CAPD) |
A type of dialysis
where a patient does multiple dialysis solution exchange via peritoneal
catheter into the peritoneal cavity by gravity. A Nephrologist will prescribe the number of exchanges needed,
typically three or four exchanges during the day. CAPD is done at home. |
|
Continuous Cycler
Peritoneal Dialysis (CCPD) |
A type of dialysis
where the patient generally dialyzes at home and uses an automated peritoneal
cycler machine to perform three to five exchanges during the night. CCPD is done at home with a machine called
a cycler. Time on the cycler can be
8-10 hours. |
|
InCenter IPD
(Intermittent Peritoneal Dialysis) |
IPD is much like
CCPD but is usually performed in the hospital. Treatment sessions may last up to 24 hours and are done several
times a week. This is an automated cycler that delivers a prescribed number
of exchanges over several hours. This
can be done daily or less frequently. |
|
Home IPD
(Intermittent Peritoneal Dialysis) |
IPD performed at
home. Treatment sessions may last up
to 24 hours and are done several times a week. This is an automated cycler
that delivers a prescribed number of exchanges over several hours. This can be done daily or less frequently. |
