Best Nephrology Billing Services
Nephrology medical billing is specialty billing and revenue cycle work built for renal practices where an ESRD monthly capitation code billed for the wrong number of visits, a CKD claim coded with an unspecified stage, or a dialysis claim submitted with the Medicare and Medicaid sequence reversed is the difference between full payment and a denial that's painful to unwind.
EverCure Billing handles the complete revenue cycle for nephrologists and renal-care groups across the United States: eligibility and dual-coverage checks, prior authorizations, nephrology coding, claim submission, denial appeals, and aged A/R recovery. Your team manages the kidney disease. We make sure the dialysis, transplant, and CKD care you already provided actually gets paid and holds up if a payer looks.
What Is Nephrology Medical Billing?
Nephrology medical billing covers every financial step between a patient encounter and that money landing in your practice account.
For a renal practice specifically, that includes verifying dialysis, transplant, and CKD coverage across both Medicare and Medicaid and sequencing them correctly, obtaining prior authorization for dialysis and interventional procedures, coding ESRD services with the correct monthly capitation (MCP) code for the number of visits, documenting CKD to the correct stage, mapping each service against the ESRD Prospective Payment System (PPS) bundle, submitting a clean claim, posting the payment, appealing the denial, and chasing the balance until it clears.
General billing doesn't juggle dual Medicare-Medicaid eligibility, ESRD PPS bundling, or stage-specific CKD documentation. Nephrology does and those rules make renal care one of the most sequencing-sensitive and documentation-dependent specialties in medicine.
Why Do Nephrology Practices Lose More Revenue Than They Should?
Because renal revenue runs on ESRD capitation codes, CKD stage-specific documentation, ESRD PPS bundling, and correct Medicare-Medicaid sequencing and each of those is easy to get wrong. These are the specific leaks we see when we run audits on nephrology practices:
Wrong Medicare-Medicaid sequencing
ESRD qualifies patients for Medicare regardless of age, which means most renal patients are dual-eligible. Send the claim to the wrong payer first, or with the coordination-of-benefits reversed, and it denies for payer or sequencing reasons.
ESRD monthly capitation (MCP) errors
The MCP codes are billed by the number of face-to-face visits in the month. Bill the wrong visit tier and the practice under-collects or bills unsupported.
Unspecified CKD staging
CMS requires stage-specific CKD codes (N18.1 through N18.6). Submit an unspecified or wrong-stage code and the claim denies or under-documents the patient's severity.
ESRD PPS bundling confusion
Under the ESRD PPS, certain drugs, labs, and supplies are bundled into one per-treatment payment while others are separately billable. Bill a bundled item separately, or miss a separately billable one, and money is lost either way.
Documentation and coding gaps
When the physician's note doesn't match the billed diagnosis, the claim is vulnerable especially on medical necessity and stage documentation.
Prior-authorization gaps
Dialysis sessions, interventional procedures, and transplant services often require authorization first. Deliver the service before the auth and the claim denies.
We build the workflow around these six failure points, because they are where renal-care revenue actually disappears.
What Nephrology Billing Services Does
EverCure Billing Provide?
Insurance eligibility and dual-coverage verification
We verify dialysis, transplant, and CKD coverage across Medicare and Medicaid and commercial payers, confirm coordination of benefits, and set the correct payer sequence before the claim drops.
Prior authorization support
We prepare and submit authorization requests for dialysis, interventional procedures, and transplant services, attach the clinical documentation, and follow up with the payer until a decision is issued.
Nephrology coding
Our coders work from your notes to assign the correct CPT, ICD-10-CM, and HCPCS codes selecting the right ESRD MCP visit tier, coding CKD to the correct stage, and mapping each service to its bundled or separately-billable status under the ESRD PPS. Coding and billing are handled together, so coding errors are caught before the claim goes out.
Charge entry and claim scrubbing
Every claim runs through a pre-submission check for MCP visit-count accuracy, CKD stage specificity, ESRD PPS bundling status, Medicare-Medicaid sequencing, and diagnosis linkage before it leaves our office.
Claim submission and clearinghouse management
Electronic submission, rejection handling at the clearinghouse level, and same-day correction and resubmission on front-end rejects.
Payment posting and reconciliation
ERA and manual EOB posting, contractual adjustment verification, and underpayment identification including catching claims wrongly billed as self-pay for insured patients.
Denial management and appeals
Every denial is categorized by root cause, corrected, and appealed with the documentation the payer is actually asking for. We also feed denial patterns back into coding so the same denial stops repeating.
Accounts receivable follow-up and recovery
Structured follow-up on aged claims by bucket (30 / 60 / 90 / 120+ days), with priority given to high-dollar dialysis and transplant claims and anything approaching a timely filing deadline.
Patient billing and support
Clear patient statements, balance explanations, and a support line so your front desk isn't fielding coverage questions all day.
Provider credentialing and payer enrollment
New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment through PECOS.
Billing audits and compliance review
Periodic internal review of CKD staging, MCP visit tiers, and ESRD PPS bundling to reduce audit exposure including quarterly review of referral patterns for Stark Law and AKS exposure.
Financial reporting
Monthly reporting on collections, clean claim rate, denial rate by reason, days in A/R, and payer performance in plain language, not a data dump.
Which Nephrology Services
Do You Bill?
Dialysis (ESRD) hemodialysis and peritoneal dialysis, with correct ESRD MCP coding by visit tier and Medicare compliance.
Home dialysis home hemodialysis and peritoneal dialysis, including transitional care management for home patients.
Transplant nephrology pre- and post-transplant care, immunosuppressive management, and follow-ups.
CKD management stage-specific CKD care with correct N18 staging and severity documentation.
Hypertensive kidney care hypertension-related renal cases linked with CKD and ESRD, coded to severity.
Dialysis access procedures AV fistula and access-related procedures where your nephrologists perform them.
Pediatric nephrology age-based CKD and dialysis coding for pediatric patients.
Office E/M and consults new and established renal visits leveled to the documentation.
Which Nephrology CPT and ICD-10 Codes
Do You Work With?
| Code / Range | What It Covers |
|---|---|
| 90951–90962 | ESRD-related services monthly capitation by age and visit count |
| 90935 / 90937 | Hemodialysis single / repeated evaluation |
| 90945 / 90947 | Dialysis other than hemodialysis (e.g., peritoneal) |
| 90963–90966 | Home dialysis monthly, by age |
| G0317–G0319 | Home dialysis transitional-care HCPCS codes |
| 36901–36909 | Dialysis-access / AV fistula procedures |
| N18.1–N18.6 | Chronic kidney disease, stages 1 through 5 |
| N18.6 | End-stage renal disease requiring chronic dialysis |
| N20.- | Calculus of kidney and ureter |
| E11.21 | Type 2 diabetes with diabetic nephropathy |
| I12.- / I13.- | Hypertensive chronic kidney disease |
The ESRD PPS base rate, bundling rules, modifier requirements, and CPT sets update over time often annually. Keeping current on all of it is part of the service, not an extra.
Which Rules and Codes Actually Decide
Whether a Nephrology Claim Gets Paid?
The theme in nephrology is that payer sequencing, MCP visit tiers, and CKD stage specificity decide payment far more than any single procedure code. That's exactly what we scrub before submission.
More than anything in nephrology, correct Medicare-Medicaid coordination and sequencing decides whether a dual-eligible claim pays. We verify coordination of benefits before every claim.
The monthly capitation code depends on the number of face-to-face visits so choosing the right tier is what makes the ESRD claim correct.
Stage-specific N18 codes drive both payment and documented severity. Unspecified staging is a top denial reason.
Mapping each drug, lab, and supply to its bundled or separately-billable status decides whether you bill it and whether it pays.
Correct modifiers on access procedures and separately-billable services keep them from bundling or denying.
The billed diagnosis has to match the note. We cross-check before release so claims aren't submitted unsupported.
How Does Compliance Work in Nephrology Billing?
Documentation and staging discipline
CKD stage codes are only defensible when the note supports the stage. We cross-check physician notes against billed diagnoses and flag deficiencies before claim release.
ESRD PPS accuracy
Bundled-vs-separately-billable status is a compliance and revenue question at once. We map each service to its current status so nothing is billed that shouldn't be, and nothing billable is missed.
Dual-eligibility integrity
Coordination of benefits between Medicare and Medicaid is verified before submission to eliminate payer-ID and sequencing errors.
Referral protection
Stark Law and Anti-Kickback Statute exposure is real in renal care. We review referral patterns periodically so flagged arrangements reach your counsel before claims drop.
HIPAA and data security
Every EverCure Billing team member works under signed HIPAA agreements with role-based access to PHI, secure data transfer, and no PHI on personal devices or unsecured channels.
How Does the
Onboarding Process Work?
Free billing audit
We review a sample of recent claims, denials, and your aged A/R to identify where revenue is being lost and how much is recoverable.
Findings and scope
You get a written summary of what we found and a clear proposal services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing EHR and practice management system. No migration, no software purchase, no disruption to your clinical team.
Workflow mapping
We document your service mix, dialysis and transplant volume, payer and dual-eligibility mix, and current denial patterns, then build the billing workflow around how your practice actually runs.
Go live
Claims start flowing through our process. In parallel, we begin working your existing aged A/R old renal money is often stuck in the 60+ bucket and recoverable.
Ongoing reporting and review
Monthly financial reporting, a dedicated account manager, and a scheduled review call.
Typical onboarding runs about two to four weeks depending on system access and practice size.
Which EHR and Practice Management Systems
Do You Work In?
We work directly in your current system rather than asking you to change platforms. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, CareCloud, Epic, and Cerner, along with the renal and dialysis platforms many nephrology groups run.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve practices nationwide.
What Does Nephrology Billing Cost?
Our nephrology billing services are priced as a percentage of monthly collections so our revenue only grows when yours does. Your exact rate depends on service mix, dialysis and transplant volume, payer mix, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. If you want a specific number, the Business Assessment is the fastest way to get one that's accurate rather than generic.
Why Choose EverCure Billing for Nephrology Billing?
We code and bill together.
In nephrology, most lost revenue is a coding decision a wrong MCP tier, an unspecified CKD stage, a reversed payer sequence. Handling coding and billing in one workflow means those errors are caught before the claim drops.
We handle the dual-eligibility and PPS tangle, not just easy claims.
Medicare-Medicaid sequencing, ESRD PPS bundling, and stage-specific documentation take real attention. That's the work we don't write it off and move on.
You get a named account manager, not a ticket queue.
One person who knows your practice, your payers, and your patient mix.
Direct access to leadership.
When something goes wrong, you're not escalating through four layers.
Denial data goes back into coding.
Every denial reason is tracked and fed back upstream so the same error stops repeating.
Transparent reporting.
You see clean claim rate, denial rate by reason, days in A/R, and collections every month.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your Nephrology Practice Leaving Money on the Table?
Most renal practices don't know how much is stuck in the 60+ A/R bucket, how many claims are denying for sequencing or staging reasons, or how much of that backlog is still collectible until someone actually looks.
That's what the Business Assessment is for. We review your recent claims, denials, and A/R and give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About Nephrology Billing
Yes. We verify coordination of benefits and set the correct payer sequence before every claim, which eliminates the payer-ID and sequencing denials that hit renal practices hardest.
Yes. We select the MCP code by the number of face-to-face visits in the month so the ESRD claim reflects the care actually provided.
Yes. We use stage-specific N18 codes and cross-check them against the physician note so the claim isn't denied for unspecified staging.
Yes. We map each drug, lab, and supply to its bundled or separately-billable status so nothing billable is missed and nothing bundled is wrongly billed.
Yes. We handle both together, which is how coding errors get caught before submission rather than in an audit.
Yes. We prepare and submit the request, attach the documentation, and follow up until a decision is issued.
Yes. New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment are all available.
Yes. We log into your current system, including renal and dialysis platforms. There is no software to buy and no migration required.
Both. Aged A/R is usually where the fastest recovery is available in renal care.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices.
Start with the free billing audit. You'll get a written picture of where your revenue is leaking before you commit to anything.
Ready to Fix Your Nephrology Revenue Cycle?
Every stuck dialysis claim and every aged account is money your practice already earned. Let's go get it.