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Form (2728, 2746) Modification Process Update

The Form CMS-2728 and Form CMS-2746  are documents that are created for a point in time. The document is submitted with information that was current at the time the patient initiated dialysis (Form CMS-2728) or at the time of the patient’s death (Form CMS-2746).   

Requests to modify a submitted Form CMS-2728 or Form CMS-2746 will only be processed under the following circumstances: 

  1. The modification request is made within 60 days of submitting the form in EQRS. 
  2. If the request is made after 60 days of submitting the form in EQRS, the only fields that will be modified are those that affect the patient’s ESRD Medicare coverage and is up to the discretion of the local ESRD Network. 
  3. Only the facility who originally submitted the Form CMS-2728 or Form CMS-2746 in EQRS can request a form change.  

NOTE:  

You should contact your ESRD Network to request CMS Form modifications. Modifications are made at the discretion and approval of each individual ESRD Network. Please note that changes made to submitted forms that are changed after the form due date will be considered late and will affect the facility’s forms compliance rates. 

Additional documentation may be required before the change is approved.