Issue
Quietest leakCapitation billed at the wrong visit tier
The denial or revenue leak it triggers
Payment for a lower level of care than delivered
How we prevent it
We confirm and document face-to-face visits every month
Specialty billing · Nephrology & kidney care
Nephrology Billing Services
Nephrology payment is assembled, not read off a single fee.
Nephrology billing services from 247 Medical Billing Services turn monthly capitation, dialysis, CKD, and vascular access into first-pass payments — with a dedicated account manager and a free 360° reporting dashboard on every account. We run the full kidney-care revenue cycle across Medicare, Medicare Advantage, and commercial payers, HIPAA-compliant and SOC 2 Type II, billing nephrology practices since 2005.
HIPAACompliant
SOC 2Type II
Billing NephrologySince 2005
360° DashboardFree
One ESRD patient
Capitation calendar · Live
One claim for the monthValue swings on visit count
Face-to-face physician visits, documented
The tier the month actually earned
One visitlowest tier
Two to three visitsmiddle tier
Four or more visitsthis month's level of care
One undocumented check-in quietly downgrades the tier
Confirmed and documented every month, not defaulted down
Filed within 24 hoursDays in A/R < 25
We work with Nephrology practices across the U.S.
Dialysis (MCP)
CKD Management
Vascular Access
Transplant Follow-Up
And More
01Refuses to act like fee-for-service
Why kidney-care revenue behaves unlike any other specialty
Dialysis is paid through a monthly capitation structure instead of per encounter. ESRD patients move through a coordination period that quietly changes who pays first. Chronic kidney disease only earns its true value when the stage and comorbidities are documented and coded. Vascular access sits in a coding world of its own.
Input 01How many times the physician saw the patient
The monthly capitation code depends on face-to-face visit count — so the same patient can generate different monthly value.
Input 02Where the treatment happened
The dialysis code depends on the setting: in-centre hemodialysis, home hemodialysis, and peritoneal dialysis each bill differently.
Input 03How well the note stages the disease
The E/M value depends on the CKD stage and comorbidities being on the record, for reimbursement and risk adjustment both.
Miss any input and the claim still pays — just at less than it should. Any one of those going wrong sends the money in one of two directions: lost to underbilling, or bounced back as a denial.
Practices that move to us
Those numbers hold cycle after cycle, which is why our client-retention rate sits at 98%:
up to 0%
Fall in denials
~0%
First-pass clean-claim rate
~0%
Net collections
<0
Days in A/R
~0 of 10
Worked denials overturned on appeal
0 hrs
Every claim scrubbed and filed within
02Rules that exist almost nowhere else
The rules that decide what a nephrology claim pays
Most billing companies process a nephrology claim the way they process any office visit — and that assumption is exactly where kidney-care revenue starts leaking. We manage each revenue stream to its own rulebook, so nothing is underbilled and nothing bounces:
| Revenue stream | What it involves | What we manage |
|---|---|---|
| Monthly capitation (MCP) | ESRD dialysis care billed once per month (90951–90970), tiered by patient age and number of face-to-face visits | The correct visit tier every month, with adequacy (Kt/V) modifiers where the payer requires them |
| Dialysis procedures | In-center and home hemodialysis and peritoneal dialysis, plus inpatient dialysis (90935–90947) | Setting-correct codes and units matched to the treatment record |
| CKD management & E/M | Office and hospital evaluation of chronic kidney disease by stage | Stage- and comorbidity-accurate documentation that captures true acuity |
| Vascular access | AV fistula and graft creation and interventional maintenance | Procedure-correct coding with the right modifiers and no unbundling |
| Coordination of benefits | The ESRD Medicare Secondary Payer coordination period | Primary versus secondary payer confirmed before every claim |
- The patient becomes ESRD-eligible
STARTA defined coordination period opens, and who pays first is no longer the obvious answer.
- Inside the window
COBThe group health plan and Medicare each have a position, and billing the wrong one first bounces the claim.
- The window closes
SWITCHThe order flips — and a practice that never tracked the date keeps billing the old way.
- Every claim, verified first
CHECKPrimary versus secondary confirmed before submission, per patient, so coordination denials stop.
PER PATIENTThe coordination period is tracked individually, not assumed from the practice's usual payer mix.
BEFORE THE CLAIMVerification happens ahead of submission rather than after a coordination-of-benefits rejection posts.
KT/VDialysis-adequacy modifiers appended wherever the payer requires them on the monthly capitation claim.
03Money lost in quiet ways
Every nephrology claim, coded to its own rulebook
A nephrology practice loses money in quiet ways — a visit tier billed low, a stage left off the note, a separately payable service folded into the bundle. We close each gap before submission rather than arguing it after the fact:
At the right tier
Monthly capitation, at the right tier. We confirm and document the number of face-to-face visits so each month's capitation is paid at the level of care you actually delivered, not defaulted to the lowest tier.
Coded to the setting
Dialysis, coded to the setting. In-center hemodialysis, home hemodialysis, and peritoneal dialysis each bill differently. We match the code and units to the treatment log every time.
Fully documented
CKD acuity, fully documented. We work alongside your clinicians so kidney-disease stage and comorbidities are captured, protecting both reimbursement and risk-adjusted quality performance.
Kept whole
Vascular access, kept whole. Fistula and graft creation, maintenance, and interventional procedures are coded with the correct modifiers and no unbundling, so no unit is lost to a generalist's shortcut.
Not lost to the bundle
Separately billable services, not lost to the bundle. Services that fall outside ESRD-related care are identified and billed with the correct modifiers instead of being written off inside the bundle. Handling all of that, on every patient, every month, is precisely what professional nephrology billing services are built to do.
04A full-time discipline
Outsource nephrology billing services
A poor fit in-house
Kidney care is a poor fit for an in-house biller who also has to know a dozen other specialties. The capitation calendar alone is a full-time discipline: every ESRD patient generates one monthly claim whose value swings on visit count, and a single missed check-in quietly downgrades the tier.
A narrow margin for error
Add the ESRD Medicare Secondary Payer coordination period, CKD staging for risk adjustment, and vascular-access coding, and the margin for error is far narrower than most front offices can staff for.
The trade
You stop losing capitation to undocumented visits, you stop eating coordination-of-benefits denials that a verification step would have caught, and you stop leaving CKD acuity — and the reimbursement attached to it — on the table. You also stop carrying the fixed cost, turnover risk, and re-training burden of an internal billing seat.
05Encounter to paid
What our nephrology billing service covers
Everything it takes to move a nephrology claim from the encounter to paid, run by one certified team rather than split across vendors:
- 01Tier
Nephrology coding & MCP management
Monthly capitation billed at the correct age and visit tier, dialysis and vascular-access procedures coded to the record, and CKD staged for full, risk-accurate value.
- 02Enrol
Insurance credentialing and payer enrollment
Nephrologists and advanced-practice providers enrolled and re-credentialed so nothing rejects on eligibility.
- 03Appeal
Root-cause denial management and appeals
Every denial worked back to its source, from coordination-of-benefits rejections to bundling disputes, and pursued through appeal.
- 04Recover
Accounts-receivable recovery
Aged claims chased relentlessly across Medicare, Medicare Advantage, and commercial payers until they resolve.
- 05Verify
Eligibility and the ESRD coordination check
Coverage and the coordination period confirmed before care, so the right payer is billed first.
- 06File
Charge capture and clean-claim submission
Treatment logs reconciled to the claim, scrubbed, and filed within 24 hours.
If you'd rather keep nephrology billing and coding services under one roof, that is exactly the model — certified coders and billers on the same team, working from the same record, instead of handing your claims between companies. It is also why practices that leave a piecemeal setup for a single specialist vendor stop seeing the same claim touched by three unrelated hands.
Revenue review
What are your missed capitation visits costing?
We'll put a dollar figure on what your missed capitation visits, unstaged CKD, and aged A/R are actually costing.
- Capitation tiers re-read against the documented visits
- Coordination periods checked for the correct primary payer
- CKD encounters reviewed for stage and comorbidity capture
HIPAA & SOC 2 Type II
Back within one business day
No long-term lock-in
Request a Revenue Review
Tell us about your practice.
A nephrology billing specialist will reach out within one business day.
Thanks — we've got it.
A nephrology billing specialist will reach out within one business day.
06Gaps a generalist never sees
Why nephrology providers choose 247MBS
Bringing us on isn't hiring a general biller who happens to accept nephrology claims. It's engaging a nephrology billing services company that already knows where kidney-care revenue leaks:
- We protect your monthly capitationVisit tiers confirmed and documented every month, so capitation is paid at the true level of care instead of defaulting down.
- We get coordination of benefits rightThe ESRD Medicare Secondary Payer coordination period tracked per patient, so the correct payer is billed first and claims stop bouncing between plans.
- We capture CKD acuityStage- and comorbidity-accurate coding protects reimbursement and keeps your risk-adjusted quality numbers where they should be.
- We keep dialysis and access cleanSetting-correct dialysis codes and properly modified vascular-access procedures, with no unbundling and no lost units.
- You always see the workA named account manager owns your account and a live dashboard shows every claim, denial, and dollar — with no long-term lock-in.
07Fluent on arrival
247MBS vs. a general biller
A generalist learns nephrology on your claims. We arrive already fluent in it — and the difference shows up on the remittance:
Capability
General billing company
247MBS
Monthly capitation (MCP) visit-tier accuracyOne missed check-in downgrades the tier.
No
Yes
ESRD Medicare Secondary Payer coordinationWho pays first quietly changes.
No
Yes
CKD staging & risk-adjusted documentationReimbursement and quality scores both.
Limited
Full
Home & in-center dialysis codingEach setting bills differently.
No
Yes
Vascular-access procedure codingA coding world of its own.
No
Yes
Dialysis-adequacy (Kt/V) modifiersRequired by some payers on capitation.
No
Yes
Dedicated account manager & live dashboardThe work stays visible.
Sometimes
Always
08Closed at the front end
The denials we prevent
Most nephrology losses trace back to the same handful of failure points. We close each one at the front end, before it becomes a denial or a write-off:
Issue
Wrong primary payer during the ESRD coordination period
The denial or revenue leak it triggers
Coordination-of-benefits denial
How we prevent it
We verify primary versus secondary before every claim
Issue
CKD stage or comorbidity not documented
The denial or revenue leak it triggers
Underpayment and weaker risk-adjusted scores
How we prevent it
We capture stage and comorbidities with your clinicians
Issue
Dialysis coded to the wrong setting
The denial or revenue leak it triggers
Denied or reduced dialysis claim
How we prevent it
We match the code and units to the treatment record
Issue
Missing dialysis-adequacy (Kt/V) reporting
The denial or revenue leak it triggers
Capitation denial or adjustment
How we prevent it
We append the required adequacy modifiers
Issue
Separately payable service folded into the bundle
The denial or revenue leak it triggers
Revenue lost inside ESRD-related billing
How we prevent it
We identify and bill non-bundled services with correct modifiers
Every one of these is preventable before submission rather than argued after the fact. Request a revenue review and we'll show you which of them is hitting your remits right now.
09The rules shift with the setting
Who we serve
The rules shift with the setting, and we bill each one to the detail it demands:
Nephrology physician practices
Solo and group, managing CKD, ESRD, transplant follow-up, and hospital consults.
What decides the moneyAcuity captured across every setting
Dialysis programs
In-center and home hemodialysis and peritoneal dialysis, where monthly capitation and treatment coding have to line up.
What decides the moneyCapitation and treatment coding in step
Combined internal medicine and nephrology groups
Mixed office E/M and kidney-care billing under one revenue cycle.
What decides the moneyTwo books under one cycle
Vascular-access and interventional nephrology
Fistula and graft creation and maintenance coded to their own rulebook.
What decides the moneyModifiers, with no unbundling
Transplant nephrology
Pre- and post-transplant management with its own coordination and documentation demands.
What decides the moneyCoordination and documentation demands
10No pause in revenue
Onboarding without a gap in cash flow
Changing billers shouldn't mean a pause in your revenue, and with us it doesn't.
Your systems stay
We work inside your existing practice-management and dialysis-tracking systems, so nobody relearns a platform.
Enrollment in parallel
Credentialing and payer-enrollment review run in parallel while your claims keep going out the door, and a named account manager leads the transition from day one.
Live in weeks
Most nephrology practices are fully live within a few weeks.
The denial drop and faster A/R turn up in the first cycles — not a quarter later.
11Reconciled to the treatment log
Medical Billing for Nephrology
Get paid the full value your kidney-care practice earns every month.
So much of nephrology revenue is assembled rather than read off a single fee: monthly capitation swings on face-to-face visit count, dialysis pays differently by setting, and a CKD visit only reaches its true value when the stage and comorbidities are on the record. 247MBS reconciles each of those inputs to the treatment log and the encounter note before a claim goes out — capitation confirmed at the right tier, dialysis coded to the setting, CKD acuity captured with your clinicians, vascular access kept whole. The payoff of putting nephrology medical billing in our hands is measurable: a first-pass clean-claim rate near 99%, up to 40% fewer denials, and days in A/R under 25, so nothing is underbilled and nothing bounces on a coordination-of-benefits technicality. Request a revenue review
- TIERCapitation confirmed at the right tierAgainst the documented visit count.
- SETTINGDialysis coded to the settingIn-centre, home, or peritoneal.
- STAGECKD acuity captured with your cliniciansFor reimbursement and risk adjustment.
- WHOLEVascular access kept wholeCorrect modifiers, no unbundling.
12Proved against your own remits
Choosing a Nephrology Billing Services Provider
Not on a sales call
The right nephrology billing services provider proves itself against your own historical remits — not on a sales call — and that is the standard we clear before you sign. Bring us on and you get a partner already living in the monthly capitation calendar, the ESRD Medicare Secondary Payer coordination period, CKD staging for risk adjustment, and vascular-access coding, instead of a generalist learning kidney care on your remittances.
We confirm the capitation visit tier every month, verify coordination of benefits before submission, capture CKD acuity with your clinicians, and let you see every claim in real time.
A company that knows where it leaks
MONTHLYThe capitation tier, confirmedBEFORECoordination of benefits, verifiedLIVEEvery claim on the dashboardFREENo long-term lock-in
We shut each gap instead of defaulting your capitation to the lowest tier and hoping you never notice.
Request a Revenue Review13A department, not a black box
Outsource Nephrology Billing — What Outsourcing Looks Like With Us
What changes hands
Outsource nephrology billing to 247MBS and you gain a kidney-care revenue department, not a black box — deep specialist expertise running as a service instead of a fixed in-house seat carrying turnover and re-training risk.
The recurring work becomes ours: certified coders confirm each month's capitation tier, verify primary versus secondary payer during the ESRD coordination period, capture CKD stage and comorbidities, and code dialysis and vascular access to the record every cycle. Outsourcing nephrology billing services this way stops you losing capitation to undocumented visits and eating coordination-of-benefits denials a verification step would have caught.
And because nephrology billing services outsourcing only earns its keep when the work stays visible, a live 360° dashboard shows every claim, denial, and dollar, with a named account manager on the account start to finish. Ready to stop leaving kidney-care revenue on the table month after month? Request a revenue review or call +1 888-502-0537.
The recurring work, ours
- Capitation tier
- COB verification
- CKD staging
- Dialysis coding
- Vascular access
- Aged A/R
EVERY CYCLECoded to the record, not to habitVISIBLEA live 360° dashboard, start to finishNAMEDOne account manager on the account
We confirm and document the number of face-to-face ESRD visits each month so the capitation code reflects the true level of care, and we append dialysis-adequacy modifiers where the payer requires them — so you're never defaulted to the lowest tier.
Yes. We track each patient's coordination period and verify primary versus secondary coverage before every claim, so the correct payer is billed first and coordination-of-benefits denials stop.
Yes. In-center hemodialysis, home hemodialysis, and peritoneal dialysis each bill differently, and we match the code and units to the treatment record for every setting.
We do. Certified nephrology coders and billers work as one team, so CKD staging, dialysis coding, capitation, and claim submission all stay aligned instead of being split across vendors.
Yes. We work with your clinicians so kidney-disease stage and comorbidities are documented and coded, which protects both reimbursement and your risk-adjusted quality scores.
Most practices are live within a few weeks. We bill from your existing systems, run credentialing and enrollment review in parallel, and assign a dedicated account manager on day one.
capitation·coordination of benefits·dialysis coding·CKD staging
Ready to get more of your nephrology claims paid the first time?
Whether you're a solo nephrologist, a large kidney-care group, or a dialysis program, our nephrology billing services protect every capitation payment, every dialysis treatment, and every stage of CKD you document. Hand capitation, coordination of benefits, and dialysis coding to a team that treats them as routine — and put the revenue you're leaving on the table back where it belongs.
Prefer email? sales@247medicalbillingservices.com