Nephrology Billing Services

Monthly capitation for dialysis patients, home dialysis, transplant follow-up and inpatient consults.

Nephrology is billed on a rhythm no other specialty uses. Dialysis patients are paid through a Monthly Capitation Payment. The amount depends on how many face-to-face visits happened that month and on the patient age. So the visit count drives the claim, not the service detail. Our nephrology billing services track visits against the MCP tier during the month, not after it closes.

The other half is everything outside the MCP: inpatient consults, vascular access procedures, transplant follow-up and home dialysis. Each has its own rules. A biller who treats nephrology as general internal medicine will under-bill the capitation and mis-bill the rest.

Our Services

The Notes and the Claim Have to Match

In nephrology billing, the clinical notes have to line up with what is on the claim, and the codes have to be exactly right. This specialty defeats a lot of billers. Our nephrology billing services give your practice a team that knows it well.

Key Attributes of Our Medical Billing Services:

  • Charge Entry

    Your claims come to us and go into our billing software. We hold accuracy above 98% within 24 hours. We get there by automating the routine steps, handling patient data carefully, checking eligibility and chasing insurers quickly.

  • Claim Scrubbing

    The Monthly Capitation Payment is checked against the documented face-to-face visit count before the claim is built. The visit count sets the tier, and the tier sets the payment.

  • Insurance and Rejection

    Nephrology rejections usually come down to a facility mismatch. The dialysis unit on the claim is not the one the physician is affiliated with on file. We reconcile affiliations before we submit.

  • Payment Posting

    MCP payments are posted per patient per month and checked against the expected tier. If a patient dropped a tier because of a missed visit, you see it straight away instead of at quarter end.

  • Patient Statements

    Statements take account of how dialysis care is paid. Patients are not billed for visits the monthly payment already covers.

    Illustration of a doctor writing a prescription for a patient

  • Optimize Efficiency

    We track visits against the MCP tier during the month, not after it closes. One extra documented visit can move a patient into a higher-paying tier, but only while the month is still open.

  • Timely Claim Submission

    MCP claims go out at month end, once the visit count is final. Inpatient consults and access procedures go out within 48 hours as normal.

  • Reporting

    Reporting covers MCP revenue per patient, home dialysis, transplant follow-up and vascular access separately, because each is paid a different way.

Procedures

Procedures We Bill Daily

Nephrology procedures connect to each other, so accurate coding matters more than usual. We bill this work every day, including but not limited to:

  • Dialysis
  • Apheresis
  • Kidney Biopsy
  • Peritoneal Dialysis
  • Access for Dialysis

Dialysis is billed monthly, not per visit

Nephrology has a payment structure that exists nowhere else in medicine, and practices new to it bill it like ordinary office care and lose most of the value.

The monthly capitation payment

For a patient on in-centre dialysis, the physician's care for the month is paid under a single monthly code. Which code applies depends on the patient's age and on how many face to face visits happened in the month. More visits, within the defined bands, pays more.

That makes the visit log a billing document. A practice that sees the patient four times and can only evidence one is paid for one. The date and the fact of each face to face encounter has to be recorded contemporaneously, by the physician or qualified practitioner who saw them.

Home dialysis and partial months

Home dialysis patients are billed under their own monthly codes, by age, and they do not use the visit count bands in the same way. Partial months happen constantly: a patient starts mid month, is admitted to hospital, transfers, or dies. Each of those has a defined way to bill the days actually managed, and practices commonly bill nothing at all for them.

Hospital care is separate

Inpatient care for a dialysis patient is not inside the monthly payment when the admission is for something else. The inpatient work is billed separately, and the month is handled under the rules for a partial month. Writing off inpatient nephrology care as already covered is a recurring and expensive assumption.

Access procedures

Fistula and graft interventions are procedures with their own codes and global periods, and they are frequently performed by the nephrologist. They are not part of the monthly payment. Where imaging guidance is included in the procedure code, billing it separately is a bundling error worth checking on the current edits.

Nephrology Credentialing and Dialysis Facility Relationships

Nephrology credentialing depends on where you see patients, and that is rarely one place. Office, hospital and dialysis unit each have their own paperwork. You need hospital privileges for inpatient consults. You need a separate arrangement with every dialysis facility where you round.

Monthly capitated payment is the part that catches groups out. Dialysis care is paid per patient per month, and the payment follows the physician the facility has on record. If the facility roster is wrong, or a new partner was never added to it, the money goes to someone else. Check that roster every month.

We handle the payer enrollment, privileging and dialysis facility paperwork together. See our medical credentialing services.