Dialysis billing runs on a monthly cycle, not a visit.
The monthly capitation rules reward getting the visit count and the patient month right, and punish treating dialysis like ordinary office billing. Most general billers have never seen these rules.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Nephrology claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Capitation tier billed at the wrong level
Monthly payment depends on the number of face to face visits in the month. Bill the wrong tier and you either lose revenue or invite a refund.
- Partial months handled incorrectly
Admissions, transplants and transfers split a patient month. The split has rules, and getting them wrong is common.
- Vascular access procedures bundled
Access placement, revision and declotting have their own bundling rules and are frequently written off as part of the monthly payment when they are not.
What we bill for Nephrology practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Nephrology accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- A nephrology coder, not a general one
The coder assigned to your account works nephrology every day. They already know which of your payers do what, and they are watching monthly capitation tiers, patient months and vascular access coding.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in nephrology it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your nephrology claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Nephrology practices
- Coders who work nephrology daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Nephrology billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Nephrology service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Nephrology practices ask
Do you understand monthly capitation tiers?
Yes, and the visit count that drives them is tracked through the month rather than reconstructed at the end.
How do you handle a mid month transplant?
As a split patient month, with the rules applied for each part of it.
Can you bill home dialysis training?
Yes, including the training sessions, which are separately payable and routinely missed.
Do you handle injectable drugs?
Yes, with units and wastage documented, because thin margins do not survive a miscount.
Have a nephrology coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.