Nephrology Medical Billing Built Around the Dialysis Month

End stage renal disease management pays by patient age and by the number of documented face to face visits during the month. We reconcile the visit count against the actual documentation before billing. Billing a higher tier than the record supports is direct audit exposure, and billing a lower tier quietly loses revenue on every patient every month, so the reconciliation runs on the full panel each cycle.

Yes. Home modalities have their own monthly codes plus training and retraining codes with specific documentation requirements. We verify that the supervision and training elements are recorded before the monthly claim is submitted, since these are the elements payers request when they review home dialysis billing.

The billing pathway changes, and applying the wrong one forfeits the monthly payment entirely. We track admissions and discharges against the billing calendar so the correct pathway is used for that month. This is one of the most common places nephrology practices silently lose revenue.

Yes. We code fistula and graft creation, revisions, thrombectomy, and angioplasty from the operative report, applying the modifiers needed to prevent improper bundling. We also handle the prior authorizations these procedures increasingly require, so approval is in place before the procedure is scheduled.