Nephrology Billing Services

Nephrology is one of the hardest specialties to bill correctly, because so much of its revenue doesn't behave like ordinary fee-for-service. Dialysis is paid through a monthly capitation structure, ESRD patients move through a coordination period that changes who pays first, chronic kidney disease has to be staged and documented to be reimbursed at its true value, and vascular-access work sits in its own coding world. Get any of it wrong and the money either disappears into underbilling or bounces as a denial. Our nephrology billing services exist to make every one of those moving parts correct before the claim goes out.

247 Medical Billing Services runs the full revenue cycle for nephrology practices, dialysis programs, and kidney-care groups — monthly capitation, in-center and home dialysis, CKD management, transplant follow-up, and vascular access alike. The result is more first-pass payments, cleaner risk-adjusted documentation, faster cash, and physicians who spend their time on patients instead of chasing rejected claims.

20+ Years in Medical Billing	99% Clean-Claim Rate	Under 25 Days in A/R
Nephrology billing since 2005	Claims built to pass on the first submission	Cash in weeks, not quarters

20+ years (since 2005) · HIPAA-compliant · SOC 2 Type II · HBMA member · AAPC/AHIMA-certified nephrology coders

What our nephrology billing delivers

Practices that move to us typically see denials fall by up to 40%, a first-pass clean-claim rate around 99%, net collections near 99%, and days in A/R pulled under 25 — with roughly nine of ten worked denials overturned on appeal. Those results hold month after month, which is why our client-retention rate sits at 98%. Every claim is scrubbed and filed within 24 hours, so revenue that used to sit in a work queue starts landing in your account instead. A free audit puts real numbers against your own remits before you change a thing.

What makes nephrology billing different

Most billing companies treat a nephrology claim like any other office visit. It isn't — the specialty runs on payment rules that exist almost nowhere else in medicine:

• Dialysis is capitated, not fee-for-service. The monthly capitation payment for ESRD care is tiered by patient age and by how many face-to-face visits the physician documents that month. Miss a visit tier, and you're paid for a lower level of care than you actually delivered.
• ESRD changes who pays first. Patients with end-stage renal disease qualify for Medicare regardless of age, but a coordination period keeps the group health plan primary before Medicare takes over. Bill the wrong payer as primary and the claim fails.
• CKD has to be staged to be worth its full value. Chronic kidney disease is a risk-adjusted, high-acuity population. If the stage and comorbidities aren't documented and coded, the practice is underpaid and its quality scores suffer.
• Vascular access is its own coding discipline. Fistula and graft creation, maintenance, and interventional procedures each carry distinct rules that a generalist rarely handles cleanly.

Managing all of it, on every patient, every month, is exactly what professional nephrology billing services are built to do.

How nephrology billing actually works

We manage each revenue stream to its own rulebook, so nothing is underbilled and nothing bounces:

Revenue stream	What it involves	What we manage
Monthly capitation (MCP)	ESRD dialysis care billed once per month (90951–90970), tiered by age and number of face-to-face visits	The correct visit tier every month, with adequacy (Kt/V) modifiers where required
Dialysis procedures	In-center and home hemodialysis and peritoneal dialysis, plus inpatient dialysis (90935–90947)	Setting-correct codes and units matched to the treatment record
CKD management & E/M	Office and hospital evaluation of chronic kidney disease by stage	Stage- and comorbidity-accurate documentation that captures true acuity
Vascular access	AV fistula/graft creation and interventional maintenance	Procedure-correct coding with the right modifiers and no unbundling
Coordination of benefits	The ESRD Medicare Secondary Payer coordination period	Primary vs. secondary payer confirmed before every claim

Every nephrology revenue stream, captured in full

A nephrology practice loses money in quiet ways — a visit tier billed low, a stage left off the note, a separately payable service folded into the bundle. We close each gap:

• Monthly capitation, at the right tier. We confirm and document the number of face-to-face visits so each month's capitation is paid at the level of care you actually provided, not defaulted to the lowest tier.
• Dialysis, coded to the setting. In-center, home hemodialysis, and peritoneal dialysis each bill differently. We match the code and units to the treatment log every time.
• CKD acuity, fully documented. We work with your clinicians so kidney-disease stage and comorbidities are captured, protecting both reimbursement and risk-adjusted quality performance.
• Separately billable services, not lost to the bundle. Services that fall outside ESRD-related care are identified and billed with the correct modifiers instead of being written off inside the bundle.

Our nephrology billing services

Everything it takes to move a nephrology claim from the encounter to paid, run by one certified team rather than split across vendors:

• Nephrology coding & MCP management — monthly capitation billed at the correct age and visit tier, dialysis and vascular-access procedures coded to the record, and CKD staged for full, risk-accurate value.
• Eligibility & benefit verification — coverage and the ESRD coordination period confirmed before care, so the right payer is billed first.
• Charge capture & clean-claim submission — treatment logs reconciled to the claim, scrubbed, and filed within 24 hours.
• Denial management & appeals — every denial worked to root cause, from coordination-of-benefits rejections to bundling disputes.
• A/R recovery — aged claims pursued relentlessly across Medicare, Medicare Advantage, and commercial payers.
• Credentialing & payer enrollment — nephrologists and advanced-practice providers enrolled and re-credentialed so nothing rejects on eligibility.

If you'd rather keep nephrology billing and coding services under one roof, that's exactly the model — certified coders and billers on the same team, working from the same record, instead of handing your claims between companies.

Why nephrology practices choose 247MBS

Bringing us on isn't hiring a general biller who happens to accept nephrology claims. It's hiring a nephrology billing services company that already knows where kidney-care revenue leaks and how to stop it:

• We protect your monthly capitation. Visit tiers confirmed and documented every month, so capitation is paid at the true level of care instead of defaulting down.
• We get coordination of benefits right. The ESRD Medicare Secondary Payer coordination period is tracked per patient, so the correct payer is billed first and claims stop bouncing between plans.
• We capture CKD acuity. Stage- and comorbidity-accurate coding protects reimbursement and keeps your risk-adjusted quality numbers where they should be.
• We keep dialysis and access clean. Setting-correct dialysis codes and properly modified vascular-access procedures, with no unbundling and no lost units.
• You always see the work. A named account manager owns your account and a live dashboard shows every claim, denial, and dollar — with no long-term lock-in.

247MBS vs. a general billing company

A generalist learns nephrology on your claims. We show up already fluent in it — and the difference shows up on the remittance:

Capability	General billing company	247MBS
Monthly capitation (MCP) visit-tier accuracy	❌	✅
ESRD Medicare Secondary Payer coordination	❌	✅
CKD staging & risk-adjusted documentation	Limited	✅ Full
Home & in-center dialysis coding	❌	✅
Vascular-access procedure coding	❌	✅
Dialysis-adequacy (Kt/V) modifiers	❌	✅
Dedicated account manager & live dashboard	Sometimes	✅ Always

The nephrology denials and revenue leaks we prevent

Most nephrology losses trace back to the same handful of failure points. We close each one at the front end, before it becomes a denial or a write-off:

Issue	The denial or revenue leak it triggers	How we prevent it
Capitation billed at the wrong visit tier	Payment for a lower level of care than delivered	We confirm and document face-to-face visits every month
Wrong primary payer during the ESRD coordination period	Coordination-of-benefits denial	We verify primary vs. secondary before every claim
CKD stage or comorbidity not documented	Underpayment and weaker risk-adjusted scores	We capture stage and comorbidities with your clinicians
Dialysis coded to the wrong setting	Denied or reduced dialysis claim	We match the code and units to the treatment record
Missing dialysis-adequacy (Kt/V) reporting	Capitation denial or adjustment	We append the required adequacy modifiers
Separately payable service folded into the bundle	Revenue lost inside ESRD-related billing	We identify and bill non-bundled services with correct modifiers

Every one of these is preventable before submission rather than argued after the fact. Get your free nephrology billing audit and we'll show you which of them is hitting your remits right now.

Who we serve

The rules shift with the setting, and we bill each one to the detail it demands:

• Nephrology physician practices — solo and group, managing CKD, ESRD, transplant follow-up, and hospital consults.
• Dialysis programs — in-center and home hemodialysis and peritoneal dialysis, where monthly capitation and treatment coding have to line up.
• Combined internal medicine and nephrology groups — mixed office E/M and kidney-care billing under one revenue cycle.
• Vascular-access and interventional nephrology — fistula and graft creation and maintenance coded to their own rulebook.
• Transplant nephrology — pre- and post-transplant management with its own coordination and documentation demands.

What switching to 247MBS looks like

Changing billers shouldn't mean a gap in cash flow, and with us it doesn't. We work inside your existing practice-management and dialysis-tracking systems, so nobody relearns a platform. Credentialing and payer-enrollment review run in parallel while your claims keep going out the door, a named account manager leads the transition from day one, and most nephrology practices are fully live within a few weeks. The denial drop and faster A/R show up in the first cycles — not a quarter later.

Nephrology billing FAQ

How do you keep our monthly capitation from being underpaid?

We confirm and document the number of face-to-face ESRD visits each month so the capitation code reflects the true level of care, and we append dialysis-adequacy modifiers where the payer requires them — so you're never defaulted to the lowest tier.

Do you handle the ESRD Medicare Secondary Payer coordination period?

Yes. We track each patient's coordination period and verify primary versus secondary coverage before every claim, so the correct payer is billed first and coordination-of-benefits denials stop.

Can you code home dialysis as well as in-center?

Yes. In-center hemodialysis, home hemodialysis, and peritoneal dialysis each bill differently, and we match the code and units to the treatment record for every setting.

Do you offer nephrology billing and coding together?

We do. Certified nephrology coders and billers work as one team, so CKD staging, dialysis coding, capitation, and claim submission all stay aligned instead of being split across vendors.

Will you help capture CKD acuity for risk adjustment?

Yes. We work with your clinicians so kidney-disease stage and comorbidities are documented and coded, which protects both reimbursement and your risk-adjusted quality scores.

How fast can our practice go live?

Most practices are live within a few weeks. We bill from your existing systems, run credentialing and enrollment review in parallel, and assign a dedicated account manager on day one.

Ready to get more of your nephrology claims paid the first time?

Whether you're a solo nephrologist, a large kidney-care group, or a dialysis program, our nephrology billing services protect every capitation payment, every dialysis treatment, and every stage of CKD you document. Outsource nephrology billing services to a team that treats capitation, coordination of benefits, and dialysis coding as routine — and put the revenue you're leaving on the table back where it belongs.

Get Your Free Nephrology Billing Audit  ·  +1 888-502-0537  · 

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