Specialized billing for nephrology practices — dialysis billing, ESRD management, CKD coding, and kidney care claims by nephrology billing experts. Serving practices nationwide across the United States.
Get Free Practice Audit Contact UsComprehensive billing coverage for your specialty
Complete hemodialysis and peritoneal dialysis billing including monthly capitation, per-visit, and home dialysis training codes.
End Stage Renal Disease billing including ESRD monthly capitation payments and related services billing under Medicare.
Accurate ICD-10 staging for Chronic Kidney Disease and outpatient nephrology visit coding with E&M level optimization.
Kidney biopsy, vascular access management, AV fistula procedures, and catheter placements billed accurately.
Nephrology denials often involve Medicare coverage rules. We appeal every denial with proper documentation.
Monthly nephrology practice financial reports with dialysis unit performance tracking and payer analysis.
Nephrology billing is really two businesses in one: the office and hospital practice that bills like other internal medicine subspecialties, and the dialysis practice that runs on the Monthly Capitation Payment system — a billing model that exists nowhere else in medicine. Getting the MCP side right is what separates profitable nephrology groups from struggling ones, because dialysis patients are the core of most nephrologists' panels.
For each dialysis patient, Medicare pays nephrologists a monthly capitation rate tiered by how many face-to-face visits occurred that month — with the top tier requiring four or more visits including one comprehensive assessment. Miss a visit in the last week of the month and the whole month's payment drops a tier; fail to document the comprehensive visit and the top tier is unreachable. We track visit counts per patient per month in real time and flag patients sitting below tier before the month closes — the single highest-value habit in dialysis billing.
The MCP system is full of edge cases: patients who start or stop dialysis mid-month, transplant months, transient patients dialyzing away from home, hospitalized spans, and home dialysis patients (billed under their own monthly structure with training codes on top). Each has specific billing rules, and each is a place where practices routinely leave money or invite recoupment. This is exactly the operational detail a nephrology-specialized billing team exists to manage.
The pre-dialysis practice has its own revenue architecture: staged CKD coding at full specificity (payer programs and risk models key off it), chronic care management and transitional care programs that most nephrology practices under-use, and dialysis-planning education services. Coding CKD stages precisely isn't pedantry — it drives everything from medical necessity for services to the practice's standing in value-based contracts.
Nephrologists live in the hospital: daily dialysis rounds, acute kidney injury consults, critical care time. Inpatient dialysis procedures and E/M share days constantly, and the rules about what bills together — critical care time versus dialysis procedure, subsequent visits versus dialysis daily codes — are strict and audited. We reconcile hospital census against billed days so no round goes unbilled and no day double-bills.
Fistulograms, catheter placements and exchanges, and access declots carry their own procedural coding, often in office-based labs or ASCs with facility billing attached. Access procedure denials cluster around medical necessity and prior authorization; our team clears both before the procedure. For groups considering dialysis billing software instead of a service — the honest comparison is in what happens when the edge cases hit, and our monthly reporting shows the MCP tier distribution most software never surfaces.
Specialties that share nephrology’s chronic-disease population and its Medicare coverage rules.
Diabetes drives most chronic kidney disease, so patients arrive from endocrinology already carrying complex coding.
Cardiorenal patients see both practices in the same month, which is where duplicate-service denials appear.
Vascular access imaging and interventional access procedures need correct professional/technical splitting.
Dialysis units sit inside larger groups, where nephrology billing rules differ from every other line.
We bill all of these in house. If your group spans several of them, multi-specialty billing keeps one team across every line — or see the full list of services.
Get a free billing audit and see how much more your kidney care practice can collect.
Get Free Practice AuditFree resources: Denial Code Lookup | RVU Calculator | AR Days Calculator | CO-151 — frequency limits on dialysis services