Visit count errors
Monthly codes denied or reduced for undocumented visits. We reconcile visits per patient per month.
Home / Specialties / Nephrology
Nephrology medical billing services
Nephrology billing centers on the monthly capitation payment for dialysis (MCP), which depends on visit counts, patient age and the modality, plus CKD management, access procedures and inpatient care. Getting the monthly dialysis codes right every month is the core of nephrology revenue.
What makes nephrology billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether nephrology claims pay the first time.
- ESRD-related services (90951–90970) are billed monthly by age group and number of face-to-face visits; the visit count must be documented per month.
- Home dialysis patients use different code families from in-center patients.
- Partial-month situations — hospitalization, transient patients, transplant — change which codes apply.
- CKD stages 3–5 management supports chronic care management and education services (G0420, G0421) that are underbilled.
Denials we see most in nephrology
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Partial-month coding
Full-month codes billed when a patient was hospitalized. We adjust to per-day codes where required.
Home versus in-center
Wrong code family for modality. Tracked per patient.
How Core MB bills for nephrology
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new nephrology providers runs in the same system, tracked live in your client portal.
- Monthly dialysis billing reconciled against visit logs, modality and hospital days.
- CKD education and care-management capture.
- Inpatient and access procedure billing coordinated with the dialysis cycle.
Everything in the service
The full revenue cycle as standard for nephrology practices, priced on what we collect for you. Take all of it, or start with one piece such as AR recovery or credentialing.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Nephrology billing questions
How does monthly dialysis billing work?
With monthly capitation codes chosen by patient age, modality and the number of face-to-face visits in the month. Documentation of each visit is what supports the code.
What happens when a dialysis patient is hospitalized?
The full-month code no longer applies; partial-month per-day codes do. We adjust the billing based on hospital days.
Do you bill kidney disease education?
Yes. CKD education sessions are payable for stage 4 patients under Medicare and are rarely billed.
How do we get started with Core MB for nephrology billing?
Send us your specialty, provider count and monthly claim volume through the quote form and we will come back with a written proposal. Transitions run alongside your current billing so nothing is dropped, and credentialing for new nephrology providers can start at the same time.
Find out what your nephrology billing is leaving on the table
Send us a snapshot of your current billing and we will come back with a quote and a realistic view of recoverable revenue.