Nephrology Billing That Pays What You Earn
Nephrology billing is dominated by dialysis monthly capitation codes, ESRD bundle billing, and the complex interaction between kidney disease management and comorbid conditions. Dialysis-related billing uses a unique monthly bundled payment system under Medicare, and the rules governing separately billable services are strict and frequently misunderstood. 360Solutions provides nephrology billing specialists who manage ESRD capitation, dialysis-related drug billing, kidney biopsy coding, and the chronic kidney disease evaluation codes that maximize revenue outside the dialysis bundle.
Where Nephrology Practices Lose Revenue
These are the coding and billing pitfalls that cost nephrology practices the most — and where our specialised billers add the most value.
ESRD Monthly Capitation Billing
Medicare pays dialysis professional services via monthly capitation codes (90951-90970) based on the number of face-to-face visits in the month and patient age. Incorrect visit count, wrong code selection, or missed months result in significant revenue loss across all ESRD patients.
Bundle vs. Separately Billable
The ESRD bundle includes most dialysis-related drugs and supplies. However, some drugs and services remain separately billable — erythropoiesis-stimulating agents, certain IV iron agents, and specific non-dialysis services. Billing bundled items separately triggers overpayment recovery.
AV Fistula & Graft Procedures
Arteriovenous fistula creation, revision, and thrombectomy procedures (36818-36832) are separately billable from dialysis. Many nephrology practices under-document the surgical indication and post-procedure surveillance, losing these high-value procedure codes.
CKD Evaluation Code Capture
Patients with CKD stages 1-4 who are not yet on dialysis represent a large billable patient population for E&M visits, eGFR monitoring, and kidney function labs. These visits are fully billable at standard E&M rates — but only when supported by comprehensive documentation.
High-Risk CPT Groups
Code ranges payers audit most aggressively in Nephrology.
Common Denial Patterns
Knowing these before submission is the difference between a 60% and a 96% first-pass rate.
ESRD capitation code with wrong visit count for the billing month
Separately billable drug claimed within the ESRD bundle period
AV fistula procedure billed without documentation of access failure or stenosis
CKD E&M billed same month as ESRD capitation without justification for separate visit
Home dialysis capitation billed when patient was hospitalized for full month
Send us your last 90 days of remittance data — we'll identify your top 3 fixable denial sources at no cost.
Request Free Audit →How 360Solutions Works for Nephrology Practices
Free 2-Week Billing Audit
We review your last 90 days: denial breakdown by category, AR aging by payer, charge lag, collection rate, and any recurring coding issues specific to your specialty. No commitment required.
Specialty Coder Assignment
You are paired with a coder trained specifically in nephrology coding. They learn your providers, your documentation patterns, and your payer mix before touching a claim.
Parallel Billing Transition
We run alongside your current billing for 10–14 days with zero cash flow disruption. Claims keep moving during the transition. Your account manager provides daily status updates.
Live KPI Dashboard
Real-time visibility into billed, paid, denied, AR aging, and collection rate — segmented by provider and payer. No black box, no month-end surprises.
Weekly Account Manager Call
Every week your dedicated account manager walks through last week's KPIs, denial trends, and any action items. Critical issues are escalated the same day — not at the next scheduled call.
Questions From Nephrology Practices
Start With a Free,
No-Obligation Audit
Two weeks, no contract. A certified nephrology billing specialist reviews your claims, denial patterns, and AR — and shows you exactly what is recoverable.