Master ESRD Billing for
Nephrology Practices
Nephrology billing is uniquely complex. From tracking Monthly Capitation Payments (MCP) for dialysis patients to managing the strict Medicare 30-month coordination period, we ensure every unit of care is fully reimbursed.
MCP Visit Tracking
We meticulously track ESRD face-to-face visits (1, 2-3, or 4+ per month) to ensure accurate age-based CPT coding (90951-90970) without missed revenue.
Why Nephrology Billing Demands Specialists
General billers struggle with the unique mechanics of nephrology. From the 30-month coordination period determining primary vs. secondary payers, to correctly billing hemodialysis vs. peritoneal dialysis, errors here lead to massive monthly revenue losses. We protect your practice with precision coding.
MCP Visit Tracking
Monthly Capitation Payments depend on exact visit counts (1, 2-3, or 4+). We cross-reference provider schedules with dialysis center logs to ensure you bill the highest allowable MCP tier.
Medicare COB Mastery
When a patient starts dialysis, commercial insurance remains primary for 30 months before Medicare takes over. We track this transition perfectly to prevent massive out-of-network denials.
CKD Education & E&M
We capture overlooked revenue by accurately billing for Chronic Kidney Disease education (G-codes) and ensuring complex E&M visits (MDM) are coded to their highest warranted level.
Securing Revenue from
CKD to ESRD Dialysis
We manage the entire lifecycle of a kidney patient's billing, tracking disease progression, coordinating payer shifts, and ensuring monthly capitation claims are flawless.
COB & Eligibility Tracking
We continuously monitor the 30-month coordination of benefits window for ESRD patients, ensuring claims are sent to the correct primary payer exactly when the transition occurs.
Dialysis Shift Scrubbing
Our coders differentiate between hemodialysis and peritoneal dialysis (which has different visit requirements), ensuring the billed CPT codes match the patient’s age and visit frequency.
Modifier Application
When evaluating a patient for an acute issue separate from their ESRD management, we apply Modifier 25 to the E&M visit to ensure you are paid for both the acute care and the dialysis management.
Aggressive A/R Recovery
If a payer denies a monthly capitation claim due to mismatched dates of service at the dialysis center, we instantly appeal with facility logs to recover the lost funds.
Stop Losing Capitation Revenue
to Tracking Errors
Partner with certified nephrology billers who understand ESRD MCP tracking, coordination of benefits, and complex CKD coding. Contact Valeria Healthcare Solutions today.