Billing for nephrology is not general billing with a different code set. Monthly capitated dialysis codes banded by patient age and visit count, which behave unlike any fee-for-service E/M.
End-stage renal disease brings Medicare eligibility regardless of age, and a 30-month coordination period where a commercial plan pays first.
At a glance
What drives the coding
Monthly capitated dialysis codes banded by patient age and visit count, which behave unlike any fee-for-service E/M.
What drives the payer behavior
End-stage renal disease brings Medicare eligibility regardless of age, and a 30-month coordination period where a commercial plan pays first.
Coding
Assigned by certified coders from your documentation.
Reporting
Denials segmented by reason, payer, and provider.
Where nephrology claims actually fail
- Monthly capitation billed with the wrong visit band
- Coordination period miscalculated so Medicare was billed first
- Vascular access procedures bundled into the monthly code
How we work it
We code from what your record documents and query you when it does not support a code, which in nephrology is where most of the avoidable exposure sits.
Denials are worked by cause rather than in queue order, so the same failure stops recurring instead of being re-worked every month.
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your current nephrology denials and aging.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes reported monthly, segmented by payer.
Nephrology — Frequently Asked Questions
Do you have coders who know nephrology?
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Yes. All coding is performed by certified coders, and specialty assignment is deliberate rather than incidental — monthly capitated dialysis codes banded by patient age and visit count, which behave unlike any fee-for-service E/M.
What makes nephrology claims deny most often?
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Three causes account for most of it: monthly capitation billed with the wrong visit band; coordination period miscalculated so Medicare was billed first; vascular access procedures bundled into the monthly code. Each is a documentation or process failure rather than a coverage dispute, which is why we report denials grouped by cause instead of as a single rate.
How do payers behave differently for nephrology?
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End-stage renal disease brings Medicare eligibility regardless of age, and a 30-month coordination period where a commercial plan pays first. That shapes which denials are worth appealing and where the front-end effort should sit, so it drives how we staff the work rather than being background color.
Do you guarantee higher collections for a nephrology practice?
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No. Payment is decided by the payer, and any firm promising a collection rate is describing something it does not control. We commit to the process and to six reported numbers you can check against your own system.
Who is responsible if a nephrology code is wrong?
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Codes are assigned from the documentation the practice provides, and where the record does not support a code we raise a query rather than infer intent. The clinical record and the certification of medical necessity remain the practice's, and claims go out under the provider's own National Provider Identifier.
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