2728 Form Submitting in EQRS On Time within 45 Days

Created 5/31/2024

CMS requires facilities to submit the 2728 Forms in EQRS within 45 Days of the patient starting as ‘New ESRD.’ 

EQRS only requires a DATE for the Patient Signature and Nephrologist Signature.

Social Security copy of the 2728 Form can be signed and submitted after 45 days.

1. Know who is responsible for submitting the 2728 Forms EQRS. 

Identify the backup person who can support them.

2. Know the nephrologists’ schedules – when they are available to sign Forms.

3. Prepare a Signatures Box at the nurses’ station for Forms that require signatures.

Use color flags to show which Forms need nephrologist signature and which need patient signature.

4. Log into EQRS: https://eqrs.cms.gov/

Admit patient into EQRS as “New ESRD'' on the date they started treatment.

At the top of EQRS click Patients → Admit a Patient.

5. After patient is admitted → on the left side of the screen click Form 2728 → Add Initial 2728. 

Fill out any data you already have (labs, vascular access, modality).

Scroll to the bottom of the 2728 Form and Save.

Scroll to the top of the 2728 Form and Print.

6. Facility has 45 Days (from patient’s ‘New ESRD’ Date) to submit the 2728 Form on time in EQRS.

Keep the printed 2728 Form in the New Patient Onboarding Packet and/or Signatures Box!!

7. Get nephrologist’s signature as soon as possible. 

Sign the same day they see the patient. 

Facility will still have 45 days to decide whether patient is ESRD and Form should be submitted, but this way you already have the signature!

Coordinate/fax Form to the nephrology office to receive signature on time.

EQRS only needs a signature date to submit the Form.

You can get the ‘original signature’ from the nephrologist any time after to send to Social Security!

8. Get the patient’s signature as soon as possible. 

Explain the Form at chairside or during intake. Request Network assistance if you need support.

9. Submit the 2728 Form in EQRS within 45 days of the Admit Date.

In EQRS, on the left, click Form 2728 and click Initial Dialysis (under Existing 2728 Forms).

Fill out any missing information (labs, vascular access, treatment information).

10. Instructions to add staff names to the 2728 Form drop-down EQRS: https://help.esrd.ipro.org/support/solutions/articles/9000206509-adding-facility-personnel-to-eqrs  

Review for accuracy.

Submit the 2728 Form! The Date Submitted will appear in EQRS.

Request Network assistance ASAP if you have any questions: https://help.esrd.ipro.org/support/tickets/new