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Patient Activity Reports (PAR)

The PAR form was updated April 10th, 2007 and is available below in either Excel or PDF format. You can tell if you have the most recent version by looking at the lower right hand of the page for "Revised 04/10/07".

• PDF PAR
• Excel PAR

While you may enter your changes directly into the spreadsheet, please do NOT email the PAR as it will be a violation of HIPAA and Privacy Act laws. The Network is required to report those violations to CMS. Faxes are acceptable.

TIPS for correctly completing the PAR

• Use the SAME date for New ESRD patients (addition code #1) as the date given in Box #25 on the 2728 form

• Report ONLY patient events that have occurred at your facility, not a patient’s new modality at their next facility.  They simply transfer out from your facility as the modality for which you treated them.

• If you know the date a patient is starting at another facility, enter that date as your transfer out date because we track continuity of care on all patients and adjust your transfer out date later to match the next facility's transfer in date.

• Select the Addition code carefully.  Do not list a patient as a New ESRD patient (#1) when they actually only transferred in from another out patient ESRD facility (#6A) where the 2728 has already been submitted.  Identify patients Returning to Dialysis After Transplant Failure as #4A – not a Restart (#3).  A Re-Entitlement 2728 form is required from your facility if the patient’s most recent transplant was more than 3 yrs prior.  A Restart patient will require a Re-Entitlement 2728 only if they’ve been off of dialysis for more than 12 months.

• Refer to our website’s Facility Directory for the CMS certified Medicare Provider Number of both your facility and of a patient’s next facility.  DO NOT give your corporate clinic number since we don’t keep track those numbers.  If you don't know the previous or new facility's provider number, at least give the facility name, street address, city & state so we can figure out exactly which facility to use.

• Include an entry that a patient expired during the same month even when you’ve entered the date of discontinued (actually the last date of dialysis at your clinic – not your facility’s official discharge date). 

• Use the date of a patients actual kidney transplant as your Transfer Out for Transplant date - not the date they went to the hospital.

• Provide patients’ Social Security numbers, not their Medicare numbers.

• We’re tracking patient modality changes in order to correctly identify a patient’s modality as of 12/31 for the Annual Survey.  So you don’t need to list temporary hemo for a PD patient unless it's expected to be a permanent change, lasts longer than 30 days, or is the current modality on 12/31.

• A patient can ONLY recover function of a native kidney, so it’s not necessary to list a patient as both Returning to Dialysis After Transplant rejection and Recovered Function.  We do not track temporary hemo while a transplanted kidney is recovering.  Be very, very sure a transplanted kidney has rejected before either listing it on the PAR or submitting a Re-Entitlement 2728 form.

© 2008 End-Stage Renal Disease (ESRD) #12 Network Coordinating Council, Inc. dba Heartland Kidney Network
This resource was (created, developed, compiled, etc.) while under contract with Center for Medicare and Medicaid Services, Baltimore, Maryland. Contract #HHSM-500-2006-NW012C. The contents presented do not necessarily reflect CMS policy.