Nephrology Billing & RCM Expertise
Maximize revenue for kidney care services — from chronic kidney disease coding to dialysis and transplant billing.
Our billing professionals ensure full compliance, reduce denials, and streamline reimbursements across the nephrology care continuum — including CKD, ESRD, hypertension management, and vascular access procedures.
Schedule a Free ConsultationAccurate Coding for CKD & ESRD
We ensure proper HCC and ICD-10 coding for all stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD), enhancing RAF scores for value-based contracts.
Common CKD Diagnosis Codes
- N18.1 – CKD Stage 1
- N18.5 – CKD Stage 5
- N18.6 – ESRD
- Z99.2 – Dependence on dialysis
- R80.9 – Proteinuria, unspecified
Risk Adjustment Factors
- Hypertension with CKD (I12.0)
- Diabetes with kidney complications (E11.22)
- Renal anemia (D63.1)
- Post-kidney transplant (Z94.0)
Complete Dialysis Billing Management
We handle all aspects of dialysis billing — including MCP, home dialysis, and inpatient/outpatient billing. Our team ensures accurate CPT use, modifier application, and QIP compliance tracking.
Hypertension & Comorbidity Capture
Nephrology patients often suffer from complex comorbidities. We ensure accurate documentation and code linkage for hypertension, diabetes, anemia, and secondary hyperparathyroidism.
Audit Readiness & Denial Recovery
We manage end-to-end audit support for MAC, RAC, and payer reviews. Denials for MCP services, missing documentation, and modifier errors are quickly appealed using customized templates.
Common Denial Reasons
- Missing nephrologist notes
- Incorrect MCP date range
- Improper use of CPT 90970
- Lack of transplant follow-up
Our Appeal Strategy
- Dedicated appeals team
- Document-driven rebuttals
- Appeals tracking & reporting
- Fast-track redeterminations
Nephrology-Specific Modifiers
Modifier accuracy is essential in nephrology claims. We ensure correct use to avoid rejections and comply with MCP and dialysis billing requirements.
| Modifier | Usage | Example |
|---|---|---|
| -PD | Peritoneal dialysis indicator | Home PD billing |
| -25 | Significant, separately identifiable E/M | MCP visit with unrelated condition |
| -59 | Distinct procedural service | Dialysis with access procedure |
What Nephrologists Say
Dr. Ravi Patel
Kidney Care Associates
"Our billing has become more streamlined and accurate. Their CKD documentation audits and MCP billing expertise are second to none."
Sandra T., Billing Manager
Renal Solutions Network
"They resolved thousands in denied dialysis claims and helped us stay audit-ready at all times."
Nephrology Billing FAQs
How do you handle MCP billing?
We track monthly visit counts, ensure correct start/stop dates, and bill using CPT 90960–90962 codes according to CMS MCP rules. Missed visits are flagged for review before submission.
What documentation is required for ESRD claims?
Physician progress notes, dialysis flow sheets, and care plans are required. We assist in organizing these documents into payer-acceptable formats.
Do you support transplant and vascular access billing?
Yes. We code and bill for AV fistula/graft placements, catheter changes, and transplant follow-ups using correct modifiers and procedure codes.