Specialty billing
Nephrology Medical Billing and Dialysis Capitation
Monthly capitation dialysis billing, ESRD management and vascular access coding across multiple care settings.
The challenge
What makes nephrology billing different
Nephrology is one of the few specialties where a large share of revenue arrives through a monthly capitation structure rather than per-encounter fee for service. Dialysis management is paid by month, by patient age band, and by the number of documented face-to-face visits within that month, which makes visit documentation directly financial in a way most specialties never experience.
Around that sits ordinary fee-for-service work in hospitals, clinics, home dialysis training and vascular access. Nephrologists routinely deliver care across four settings in a week, and place of service accuracy on every one of those claims matters.
Why us
Why nephrology groups work with us
Specialty billing is not a marketing label for us. Coders and A/R staff are assigned by specialty, so the person on your account reads notes like yours every day.
Get a free assessment- Monthly capitation claims built from actual documented visit counts, not assumptions
- Place of service accuracy across clinic, hospital, dialysis facility and home
- Home dialysis training and support coded as its own revenue stream
- Vascular access procedures reconciled against the interventional record
Scope of work
What we handle for nephrology practices
The work below is specific to this specialty, not a generic billing checklist with the name swapped out.
Monthly capitation billing
ESRD monthly service claims built to the correct age band and documented visit tier.
Home dialysis management
Home and peritoneal dialysis training, support and monthly management captured separately.
Inpatient nephrology
Hospital consultations, critical care and inpatient dialysis coordinated with the facility record.
Vascular access procedures
Fistula and graft interventions coded to the technique and vessel documented.
Transplant follow-up care
Post-transplant management coded correctly against the transplant global period rules.
Chronic kidney disease management
Pre-dialysis CKD staging, education services and chronic care management where eligible.
The Right Way difference
The details we watch on nephrology claims
These are the details that separate a paid claim from an appealed one in nephrology. They are checked on every claim, not sampled.
- 01 Documented face-to-face visit counts within the month, which set the capitation tier
- 02 Partial-month scenarios such as transplant, hospitalisation or a change of provider mid-month
- 03 Correct separation of dialysis-related services from unrelated evaluation and management work
- 04 Place of service coding, where the same physician may bill from four settings in a single week
- 05 CKD stage documentation supporting the diagnosis codes carried on the claim
0+
Years running revenue cycles for physician practices
0+
Providers billed for across every specialty we serve
0%
First-pass clean claim rate
0 days
Median days in accounts receivable
Questions
Nephrology billing questions
What practices in this specialty ask us most often before making a change.
Ask us something elsePartial-month rules apply, and the claim has to reflect the days of responsibility rather than a whole month. We track admissions, transfers and transplants against the capitation period so these are billed accurately rather than in full or not at all.
Yes. Access procedures are ordinary fee-for-service work and must be coded to the specific technique and vessel documented in the interventional report, which is where most of the coding error in this area sits.
We coordinate with it, though the facility bills its own composite rate separately. What matters is that the physician monthly service claim reflects the visits actually documented at the facility.
How it works
Getting started takes about a month
The same four steps whichever specialty you are in. No system migration and no gap in your cash flow.
-
01
Revenue assessment
We audit a sample of your claims, denials and aged A/R and show you what we found. Free, and yours to keep either way.
-
02
Scope and agreement
A written scope covering exactly which services we run, what it costs and what we are accountable for.
-
03
Access and onboarding
We set up inside your existing EHR and clearinghouse. Two to four weeks, run in parallel with your current process.
-
04
Live and reporting
We take over submission and follow-up, and you get monthly reporting you can actually act on.
Free consultation
Let us look at your nephrology claims
Send us a sample and we will tell you specifically what is being coded, denied or under-paid — and what it is worth to fix. Free, and yours to keep.