U.S.-based nephrology billing experts ensuring accurate ESRD coding, 98% clean claim rate, and full CMS compliance for dialysis centers and nephrology practices nationwide.
Request a Free RCM AuditExpert use of CPT 90951–90970 for in-center hemodialysis, 90935/90937 for peritoneal dialysis, and 90963–90966 for home dialysis with correct QPP modifiers.
Full adherence to Medicare ESRD Prospective Payment System (PPS), including bundled drugs, labs, and facility services to prevent overpayment recoupments.
Accurate billing for home dialysis setup, patient training (90989), and monthly management with proper frequency and documentation.
We validate outlier payments, QPP adjustments, and low-volume adjustments to ensure full reimbursement for complex cases.
Monthly reports on missed ESRD codes, underbilled sessions, and payer underpayments to recover lost revenue.
Work with coders who understand ESRD bundles, dialysis workflows, and CMS quarterly updates.
Nephrology billing requires precision in ESRD coding, bundling rules, and outlier validation — errors lead to automatic denials or recoupments.
Using 90935 instead of 90970 for monthly management triggers 50–100% revenue loss per patient.
Unbundling labs or drugs outside of CMS exceptions causes overpayment recoupments and audits.
Failing to validate outlier costs for complex patients results in $100–$500 lost per session.
Charge capture delays between nurse documentation and billing result in under-coded sessions.
A seamless, 5-step workflow designed for dialysis centers and nephrology practices.
Verify Medicare ESRD eligibility, QPP status, and commercial coverage before treatment.
Assign accurate CPT codes with correct modifiers based on session type, frequency, and complexity.
Submit claims with ESRD PPS validation and outlier cost verification.
Appeal denials within 48 hours for coding, bundling, or documentation issues.
Deliver monthly KPIs: missed ESRD codes, outlier recovery rate, net collection %, and payer performance.
Clean Claim Rate
Fewer Claim Denials
Recovered Outlier Revenue
Based on 18 nephrology clients served in 2024. Results may vary.
Learn how ESRD bundling errors, missing outlier claims, and modifier mistakes cost dialysis centers thousands monthly.
Explore More →Discover how to identify and bill for high-cost dialysis sessions to recover 100% of eligible outlier reimbursement.
Read Guide →The average dialysis center loses 20–30% of revenue to preventable denials and coding errors.