Nephrology Medical Billing Services

Dialysis capitation, access procedures and CKD care, billed on the calendar this specialty runs on — accurate monthly billing from Elite Bill Care.

Nephrology runs on a payment model unlike any other specialty. Most practice revenue is tied to Medicare's monthly capitation for dialysis patients, layered with chronic kidney disease office care, hospital rounding, and vascular access work — and a single wrong code tier or undocumented visit can underpay an entire month of care. Elite Bill Care's nephrology medical billing services are built around that calendar-driven model: every dialysis month, every visit, and every access procedure tracked so claims go out complete, correctly tiered, and on time.

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What our nephrology medical billing services cover

ESRD monthly capitation — the 90951–90970 code family, selected by patient age, the number of documented face-to-face visits in the month, and whether the month was full or partial; home dialysis months billed with the home codes in the same family.
Dialysis-related encounters — inpatient hemodialysis and peritoneal services (90935/90945 families) billed alongside the monthly service only where the rules separate them, never packaged or duplicated in error.
Vascular access work — AV fistula and graft creation, plus angioplasty, thrombectomy, and stent interventions in the 36901–36909 family, with same-session hierarchy and bundling rules applied before submission.
CKD and office care — evaluation and management visits staged with the N18 diagnosis family, anemia and mineral-and-bone management, and transplant evaluation support, documented to medical-necessity standards.
Catheter and access imaging services — tunneled catheter placement and dialysis circuit imaging billed with the correct component and place-of-service coding for office, facility, and hospital settings.

Where nephrology claims break down

The ESRD coordination period. When a patient first becomes entitled to Medicare through ESRD, an employer group plan often stays primary for a 30-month coordination period. Billing the wrong payer first — or missing the month the balance flips — creates denials and refund exposure, so entitlement status has to be re-verified, not assumed.
Partial months billed as full months. Hospitalization, transplant, travel, or a death mid-month changes the capitation tier. Billing a full month in error overpays the practice and invites recoupment; billing a partial month as full-visit tier when visits were missed underpays it.
Visit documentation gaps. The monthly tiers depend on documented face-to-face visits. Thin notes downgrade the month, and the difference repeats across the whole dialysis panel.
Setting and place-of-service errors. Office, dialysis facility, and inpatient services follow different rules. A mismatched place of service is one of the fastest denials in this specialty.
Access procedure packaging. Multiple interventions in a single session follow strict hierarchy rules. Generalist coders routinely bill components Medicare considers packaged into the primary procedure.

How we run it

Nephrology billing is managed against the calendar. Before each month closes, we reconcile your dialysis roster: who dialyzed where, who was hospitalized, who received a transplant, who traveled. Visit notes are chased before code tiers are selected — not after a denial arrives. Charges are submitted, remittances posted, and payments compared against the expected capitation for each patient, so a short-paid month is visible immediately. Eligibility is re-checked monthly because ESRD coverage changes: coordination periods end, patients move between Medicare and Medicare Advantage, and those changes decide who gets billed first. Denials are worked by senior billers who know the difference between a documentation problem, a tier problem, and a payer error, and appeals are filed with the records that prove it.

Why practices choose Elite Bill Care

Our team brings 10+ years of experience in specialty medical billing, maintains a 98% first-pass clean claim rate, and helps practices achieve up to 30% denial reduction through disciplined charge review and follow-up. We serve nephrology practices in all 50 U.S. states, and every workflow runs on HIPAA-compliant processes, whether your panel is a single dialysis unit's rounding list or a multi-site group.

Software and systems we work with

We bill inside the systems your practice already uses, including TherapyNotes, Tebra, AdvancedMD, athenahealth, eClinicalWorks, DrChrono, Office Ally, CollaborateMD, NextGen, and Practice Fusion. Dialysis rosters, hospital schedules, and access-procedure logs are reconciled against charges in your own system, so nothing depends on spreadsheets living outside your record.

Frequently asked questions

Do you bill the monthly dialysis capitation codes?

Yes. We manage the full 90951–90970 monthly family, selecting each patient's code by age, documented visit count, and full- versus partial-month status. Rosters are reconciled before submission each month so hospitalization, transplant, and travel days are reflected in the tier billed.

What happens when a patient is hospitalized or transplanted mid-month?

The month is billed at the correct partial tier rather than the full-month rate, with the supporting documentation gathered first. This protects the practice both ways: no underpayment for the visits that did occur, and no overpayment that a payer can later recoup.

Can you handle our vascular access procedures?

Yes. We bill fistula and graft creation and the intervention family — angioplasty, thrombectomy, and stents — applying the same-session hierarchy and bundling rules before claims go out. Access work is high-value and heavily edited by payers, so it gets a dedicated coding review.

Which payers do you bill for nephrology practices?

Medicare is primary for most ESRD patients, and we also bill Medicare Advantage, Medicaid, and commercial plans. Because ESRD entitlement follows its own rules — including the 30-month coordination period — we re-verify coverage monthly instead of relying on intake data.

Ready to clean up your dialysis billing? Get a free consultation and we will review your current capitation accuracy, denial patterns, and month-end process.