Crosswalk

Revisions to Form CMS-685 ESRD Network Semi Annual Cost Report Forms

Issue #	Cell, Column or Row	Action to be performed	Changes to the Spreadsheet	Reason for the Change
	A1	Revise as follows:	Replace: Network Semi Annual Jan-Jun With: Network Semi Annual December-May	Revised for clarification purposes and to align with the new SOW.
	Row 34	Delete	Delete Physician/MRB Reviewers	Revised to align with new SOW.
	Row 47 to 52	Replace	Delete 1. Rent, 2. Furniture & equipment, 3. Telephone Expenses, 4. Insurance, 5. Other (attach Schedule), and G&A Subtotal rows. Add: Indirect Costs (if applicable)	Breakdown of G&A costs not needed. “G&A” is specific while we need all the Indirect costs to be included in that line, thus the change.
	Other Direct Costs (Column A)	Add 5 rows	Add to cell A45: 1. Postage & Express Mail Add to cell A46: 2. Meetings & Conferences Add to cell A47: Printing & Reproduction Add to cellA47 Add to cell A48: Other (attach Schedule) Add to cell A49: SUBTOTAL – Travel & ODCs	Added the most used ODC categories in order to make it easier to fill out the form.
	Row 4 Medicare Costs 7 - 16	Revise as follows:	Replace:  Patient and Family Engagement (c.4.1.A) Evaluate and Resolve Grievances (C.4.1.B.1) Promote Use of ICH CAHPSs (c.4.1.B3) Address Issues Identified through Data Analysis (C.4.1.B.4) Patient Appropriate Access to in Center Dialysis Care (C.4.1.C) Vascular Access Management (C.4.1.D) Patient Safety: HAIs (C.4.1.E) With: 7. Patient Engagement (C.4.1.A) 8. Patient Experience of Care (C.4.1B) 9. Vascular Access Management (C.4.1.D) 10. Patient Safety: Healthcare-Associated Infections (C.4.1D) 11. AIM2: Better Health for the ESRD Population (C.4.2) 12. Support for ESRD QIP 7 Performance Improvement on QIP Measures (C.4.3.A) 13. Support for Facility Data submission to CROWNWeb and NHSN (C4.3.B)	Revised because previous titles are outdated because a new Statement of Work (SOW) has been issued. New titles align to the new SOW.
6.	Columns T,U,V,W,X,Y	Delete	Delete the following columns: Population Health Innovation Projects (C.4.2) Support for ESRD QIP & Performance Improvement on QIP Measures (C.4.3.A) Support for Facility Data Submission to CROWNWeb and NHSN (C.4.3.B)	Delete as the titles are no longer part of the new SOW.
7.	Tab Name	Replace	Replace: Network Semi Annual Jan-June With: Network Semi Annual Dec-May	Revised to align with the new SOW period of performance.
8.	Tab Name for second spreadsheet	Replace	Replace Tab name: Network Semi Annual July-Dec With Tab name: Network Semi Annual June-Nov	The tab name reflects the applicable 6 month reporting period, as per the new SOW.
9.	Row 4 Medicare Costs	Replace	Replace: 17. BASE CONTRACT ONLY (Columns 5-16) 18. SPECIAL PROJECS With: 14. BASE CONTRACT ONLY (Columns 5-13) 15. SPECIAL PROJECS	Revised to align with new SOW.
10.	Row 4 Medicare Costs (second spreadsheet)	Replace	Replace: 17. BASE CONTRACT ONLY (Columns 5-16) 18. SPECIAL PROJECS 19. CUMULATIVE TOTAL (January – December) 20. CUMULATIVE TOTAL (January – December) With: 14. BASE CONTRACT ONLY (Columns 5-13) SPECIAL PROJECS 16. CUMULATIVE TOTAL (December – November) 17. CUMULATIVE TOTAL (December – November)	Revised to align with new SOW.
11.	Row 28	Revised as follows:	Deleted “OT and Bonuses (attach Schedule)” and blacked out the whole row.	Bonuses should not be a direct cost. They should be a cost element within the fringe pool.

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