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Timely 2728 form submission directly impacts a dialysis facilitys QIP (Quality Incentive Program) score and potential reimbursement amount. Required for all new ESRD patients within 45 days of their first treatment. The 2728 form should NOT be completed for AKI (Acute Kidney Inquiry) patients.
In 1973 Congress extended Medicare coverage to all patients, regardless of age, with end-stage renal disease. This decision was motivated by the prohibitive cost of dialysis to individual patients and the expectation that the total cost to Medicare would be low because only 16,000 patients required dialysis in 1972.
2728 Forms are submitted in EQRS: . Submitted within 45 days of the Admit Date (Field 24).
If you receive a regular course of dialysis at an inpatient or outpatient dialysis facility, you are eligible for Medicare starting the first day of the fourth month you receive dialysis. For example, if you began receiving dialysis on June 5, your Medicare coverage starts September 1.
PRIMARY CARE PROVIDER/TREATING PHYSICIAN/SPECIALIST, please complete.
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