2744 Form Instructions: Dialysis Facilities

Updated 2/14/2024

Corporate Support for 2744:

• American Renal Associates: ahannah@americanrenal.com
• Davita: 2744@davita.com
• DCI: Geraldine.bojarski@dciinc.org
• Dialyze Direct: mnees@dialyzedirect.com
• FMC: 
  • NW1: Kerry.Anderson@freseniusmedicalcare.com
  • NW2: Crystal.Rosado@freseniusmedicalcare.com
  • NW6: Lisa.Sabourin@freseniusmedicalcare.com
  • NW9: Patricia.Kulesza@freseniusmedicalcare.com 
• USRC: USRC-EQRS@usrenalcare.com  

• Contact the CMS Help Desk: qnetsupport-esrd@cms.hhs.gov 

• Submit a Ticket to the Network Data Staff: https://help.esrd.ipro.org/support/tickets/new

• Schedule an Appointments with Network Data Staff: 
  • https://calendly.com/mornings_one_on_one_support
  • https://calendly.com/slyulkin/45min
  • IMPORTANT: Use your work-email and work-phone number to schedule an Appointment
  • IMPORTANT: Include your CCN and Facility Name when scheduling an Appointment

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Medicare-certified facilities are required to complete the CMS Annual Facility Survey (Form 2744) each year. 

The 2744 collects admits, discharges, treatments, and staff numbers for the previous calendar year. 

• CMS Requirements for 2744 Form Completion

• CMS Training (from 2020):
  • Presentation recording
  • PDF of presentation

1. Log in to EQRS https://eqrs.cms.gov/ --> Facilities --> Form 2744

2. Select the correct Survey Year for the 2744 (the prior calendar year)

3. Search for your 2744:

   Missing (if it has not been created yet); click ADD to create new 2744

   Existing (if returning to work on 2744); click VIEW to enter an existing 2744

 4. IMPORTANT: the 2744 will not show the most current data until you click EDIT --> Generate

     Do this each time you modify patient data from the 2744 survey year. 

5. The 2744 shows the summary/total of all patients in the facility during the 2744 survey year. 

    Review each field to make sure it is showing accurate data.

If you see discrepancies, run the Patient Roster Report and Patient Events Report to identify which patient records need corrections.

Click Generate to refresh the data after updates are made to patient records.

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REPORT Patients Receiving Care Beginning of Survey Period

Shows patients admitted to your facility at the beginning of the Survey year (patients already admitted as of January 1st). 

Shows which patients populate Fields (01), (02), and (03). 

Includes columns:

• Admit Dates / Admit Reasons
• Patient SSN / MBI 
• Primary Dialysis Setting
• Dialysis Training Type

 REPORT Additions During Survey Period

Shows patients admitted to your facility during the Survey year (patients admitted between Jan 1st and Dec 31st).

Shows which patients populate Fields (04 A/B), (05 A/B), (06 A/B), and (07 A/B). 

REPORT Losses During Survey Period

Shows patients were discharged from your facility during the Survey year (discharged between Jan 1st and Dec 31st).

Shows which patients populate Fields (08 A/B), (09 A/B), (10 A/B), (11 A/B), and (12 A/B). 

REPORT End of Survey Report

Shows patients that are currently admitted in your facility at the end of the Survey year (as of December 31st).

Shows which patients populate Fields (14), (15), (16), (17), (18), (19), (20), (21), (22), (23), (24), (25), (26), (27), (28), (27), (30), (31), (32), (33), (34), and (35).

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6. Complete the following fields manually by entering totals for the 2744 survey year.

Excerpt from CMS-2744 Annual Facility Form Instructions refer to Fields (37) and (38) below.

INCLUDE Transient Treatments in Outpatient Treatments.

 7. Review the Remarks/Comments for anything that needs attention. 

     Make sure the Date Generated is current.

     Make sure there are no Errors or Warnings listed.

       Warnings can be resolved if you leave a comment addressing it.

        Errors must be resolved, do NOT Submit the 2744 without resolving any Errors. 

            Please schedule an appointment [Morning-Coming Soon] and [Afternoon-Coming Soon] or open a FreshDesk Ticket for assistance. 

Do NOT submit with any Errors!

8. Check the status of your 2744 to view the Reason why it may have been rejected:

2744 Status Types:

Final: facility submitted, Network has not reviewed it yet

Accepted: Network accepted the 2744 as done, will Finalize

FINALIZED: Network has Finalized the 2744, facility is done for the year

Rejected: Network rejected the 2744 for a reason described in the 'Reason' section of the screenshot below

Re-Opened: Help Desk reopened the 2744 at the Network's request, as per the facility's request

• Known glitches/workarounds/tips include: 
  • ‘0s’ in data fields à click Generate again until actual numbers appear.
  • 2744 Reports showing NULL à use the Chrome Browser in Incognito mode.
  • Numbers are not accurate à be sure you are working on 2022 à Submit a Help Desk Ticket.
  • Field 37 = [# of ICHD Patients] x [3x week] x [52 weeks/year]
  • Field 38 = [# of HHD/PD Patients] x [# of times trained at your facility] 

Do NOT submit with any Errors!