Nephrology Medical Billing Services in the USA
Partner with Nephrology Billing Experts to Protect Every Dollar
Billing for nephrology isn’t just about claims—it’s about managing dialysis, CKD, bundled payments, and Medicare rules without missing revenue. At Medix Revenue Group, we help nephrologists nationwide streamline their revenue cycles, reduce denials, and ensure timely payment.
Why Nephrology Billing is So Challenging
Nephrology billing is one of the most intricate areas in medical billing. Without specialized expertise, practices often leave thousands of dollars on the table every month.
Dialysis Billing Errors: Medicare dialysis billing (CPT codes 90935, 90937, etc.) is complex, and mistakes can result in costly denials.
ESRD Bundled Payments: CMS’s PPS model combines laboratory tests, medications, and services. Without proper tracking, practices underbill.
CKD Documentation Requirements: Nephrologists see ESRD patients monthly; missed notes = lost compliance + revenue.
High Audit Risk: Payers review nephrology claims closely, particularly those for dialysis and laboratory work.
Patient Collections: Rising deductibles mean patient responsibility accounts for a larger share of revenue.
Denials & AR: Denial rates can reach 15–20% in nephrology without expert intervention.
How Medix Revenue Group Helps Nephrology Practices
At Medix Revenue Group, our nephrology billing solutions combine certified coders, payer expertise, and proven RCM workflows.
Dialysis Billing Mastery: Correct coding and compliance for all dialysis types (in-center, home, peritoneal).
Bundled Payment Navigation: ESRD PPS optimization to ensure you don’t leave revenue behind.
Aggressive Denial Management: We recover 25–30% more on denied claims than the industry average.
Patient Billing Support: Easy-to-read statements, flexible payment options, digital reminders.
Compliance Confidence: Documentation reviews keep your practice audit-ready.
Analytics That Matter: Live dashboards track AR days, denial rates, payer lags, and revenue trends.
Our Core Nephrology Billing Services
Dialysis Billing (In-center, Home, Peritoneal)
We manage complex dialysis billing codes and compliance for all settings, ensuring accurate reimbursement every time.
ESRD & CKD Coding (Stages 1–5, ESRD)
Our certified coders accurately capture precise ICD-10 codes for every stage of kidney disease, maximizing payment and compliance.
Bundled Payment Compliance (ESRD PPS)
We help nephrology practices navigate CMS’s bundled payment system, preventing underbilling and revenue loss.
CPT & ICD-10 Coding Audits for Nephrology
Regular audits catch errors early, keeping your claims clean and your practice audit-ready.
Claim Submission & Real-time Tracking
Claims are filed electronically with payer tracking, which reduces turnaround times and boosts cash flow.
Denial Management & Appeals
Our specialists address the root causes of denials and aggressively fight appeals to recover lost revenue.
A/R Management & Patient Collections
We reduce AR days with systematic payer follow-ups and improve patient collections with clear statements and reminders.
Regulatory Compliance & Audit Prep
We monitor payer and CMS rules to ensure your practice remains fully compliant and prepared for any audit.
Financial Analytics & Reporting
Transparent dashboards and performance reports give you full visibility into revenue, denials, and payer behavior.
We know the rules, so your practice gets every dollar it deserves.
Billing for nephrology isn’t just about entering codes—it’s about understanding how each payer treats ESRD, CKD, dialysis, and transplant services. At Medix Revenue Group, we’ve built deep expertise in payer-specific rules, ensuring your claims are approved the first time.
Medicare
Covers ESRD dialysis under the Prospective Payment System (PPS).
Monthly Capitation Payments (MCP) for patients with CKD and ESRD must meet strict documentation standards.
We ensure modifiers, frequency, and compliance with CMS’s bundled rules are always accurate.
Medicaid
Varies by state and requires close attention to pediatric nephrology, transplant coverage, and dialysis authorizations.
We track and adapt to state-specific policy changes to prevent payment disruptions and ensure uninterrupted service.
Commercial Insurance Plans
Prior authorizations are common for dialysis sessions, biologics, and high-cost labs.
We streamline prior authorization workflows and prevent denials caused by missed payer rules and regulations.
Medicare Advantage (MA)
Covers a growing percentage of ESRD patients—currently over 40% of dialysis patients are in MA plans.
Requires detailed encounter documentation and payer-specific billing adjustments.
Our team ensures smooth billing despite the added administrative layers.
Did you know? A single missed modifier on a dialysis claim under Medicare PPS can cost a practice between $250 and $500 per session. Medix Revenue Group prevents these costly errors with proactive audits.
Technology We Use
Medix Revenue Group integrates with your existing systems for smooth workflows:
- EHR Systems: Epic, Athenahealth, Cerner, NextGen, eClinicalWorks.
- PMS Platforms: Kareo, AdvancedMD, Allscripts, DrChrono.
- Clearinghouses: Availity, Waystar, Change Healthcare.
- Analytics Dashboards: Track AR, denials, collections, payer behavior.
Let’s Simplify Your Nephrology Billing
Your focus should be on treating patients with CKD, ESRD, and those undergoing dialysis—not chasing claims. At Medix Revenue Group, we combine certified coders, payer expertise, and proven technology to help nephrologists capture every dollar they deserve. From dialysis billing to bundled payments and AR recovery, we make nephrology billing stress-free and profitable.
Yes. We specialize in Medicare dialysis billing, including CPT codes 90935, 90937, 90945, and 90947, as well as full ESRD PPS compliance. Our team ensures that your dialysis sessions are coded correctly, frequency limits are met, and no reimbursement is left unclaimed.
Our coders carefully separate billable from bundled services (such as labs and injectables) and apply the correct modifiers (e.g., AY, KX). We also conduct monthly audits to ensure that PPS payments comply with CMS rules, thereby preventing silent revenue leaks.
Absolutely. We scale with your practice—whether you’re a solo nephrologist or a multi-state dialysis network. Each location gets customized reporting, centralized billing workflows, and unified AR follow-ups so nothing slips through.
We handle prior authorizations for biologics, EPO agents, and medications related to dialysis. Our team manages documentation, submits requests, and tracks payer approvals to avoid delays in both care and payments.
Most nephrology practices see reduced denials within 30 days and stronger collections within 90 days. On average, clients report a 25–35% increase in clean claim rates and 20% fewer AR days in the first quarter.
Yes. We issue easy-to-understand statements, offer payment plans, and provide patient support lines—helping you improve collections without damaging patient trust.
We stay ahead of Medicare ESRD PPS updates, state Medicaid rules, and commercial plan changes. Additionally, we conduct quarterly compliance reviews to ensure your practice is always audit-ready.