Medical billing for nephrology practices is not office-visit billing. A nephrology group's revenue comes from three places at once: office care, hospital work, and monthly dialysis management. The billing team has to reconcile all three across physicians and locations.

Monthly dialysis management is the center of the problem. Medicare pays most outpatient dialysis-related physician services through a monthly capitation payment (MCP), not a claim for every treatment. For adult patients, the in-center code depends on how many qualifying face-to-face visits are documented in the month (90960 for four or more, 90961 for two to three, 90962 for one). Home dialysis uses a different monthly code (90966) that is not tiered by visit count. A missed patient-month, a tier that does not match the notes, or a duplicate monthly claim each cost the practice money or create a compliance exposure.

Our approach: reconciliation. Nexsys verifies that the group's documented work becomes the correct claim. For each month we reconcile:

  • The dialysis census against claims, so every patient is billed or has a documented reason not to be
  • Visit counts and documentation against the code billed
  • Covering physician and advanced practice provider encounters, so shared coverage ends up on one monthly record under the right billing provider
  • Duplicate or overlapping monthly claims
  • Hospital admissions, discharges, transfers, new dialysis starts, deaths, and modality changes, before the monthly claim is released

Inpatient physician services are reconciled separately from the monthly claim, and home and in-center patients are tracked by modality and effective date.

Both directions of the bundling problem. The MCP covers most outpatient dialysis-related physician services, so some separate office or outpatient services are included and deny if billed on their own. We also look for payable work that is left unbilled because everything is assumed to be bundled.

Reporting that separates the work. Monthly reports show office, hospital, and dialysis management separately, with dialysis-specific measures such as unbilled patient-months, unresolved documentation, and documentation-supported code selection, so an overall collections number does not hide a specific problem.

What Nexsys handles for nephrology practices:

  • Charge capture across office, hospital, and dialysis rounding
  • Monthly dialysis management claim review and reconciliation
  • CPT, ICD-10, and HCPCS coding review
  • Claim submission, payment posting, and denial management
  • Accounts receivable follow-up
  • Reporting by service line

FAQ

What does Nexsys do for nephrology practices?

Nexsys provides outsourced medical billing and revenue cycle management for independent nephrology practices. That covers charge capture, coding, claim submission, denial management, payment posting, and reporting that separates office visits, hospital work, and monthly dialysis management so a single collections number does not hide a specific problem.

How is nephrology billing different from general medical billing?

Nephrology billing combines office care, hospital work, and monthly dialysis management. Medicare pays most outpatient dialysis-related physician services through a monthly capitation payment (MCP) rather than a claim for each treatment, and the adult in-center code depends on the number of documented face-to-face visits in the month. Home dialysis uses a separate monthly code. These activities have to be reconciled across physicians and locations.

How does Nexsys keep monthly dialysis claims accurate?

Nexsys reconciles the dialysis patient census against documented encounters and the monthly claims. The review looks for patients with no claim and no documented reason, claims whose visit tier does not match the documentation, missing notes from covering physicians or advanced practice providers, and duplicate monthly claims, which CMS treats as an overpayment recovery issue.

Does Nexsys handle hospital and home dialysis billing for nephrologists?

Yes. Hospital professional charges are reconciled separately from the monthly dialysis claim, and home dialysis is tracked by modality and effective dates rather than as another in-center visit tier. Admissions, transfers, new dialysis starts, and modality changes are reviewed before the monthly claim is released. Coding decisions are validated against current CPT guidance, Medicare contractor rules, and each payer's policies.