Outsource nephrology billing to Nevada specialists. Certified coders for ESRD monthly capitation, dialysis, CKD and access claims. Fewer denials, no contract. Free audit.
Nevada Medical Billing Services provides end-to-end nephrology medical billing services for Nevada kidney care practices, from ESRD monthly capitation and dialysis coding to CKD visits, access procedures and denial recovery. Our certified coders reconcile every visit across every dialysis unit and bill the right payer first, targeting a 95%+ clean claim rate and under 35 days in A/R. Your nephrologists carry patients through a lifetime of kidney care; we make sure every month of it is paid.
HIPAA compliant · Signed BAA · No obligation
95%+
clean claim rate target
<35
days in A/R
HIPAA
compliant with signed BAA
Flexible
no long-term contract
Nephrology billing services are specialized revenue cycle management services for kidney care practices. They cover eligibility and coordination-of-benefits checks, CPT and ICD-10-CM coding, ESRD monthly capitation reconciliation, claim submission, payment posting, denial management and A/R follow-up for chronic kidney disease visits, in-center and home dialysis, acute kidney injury, kidney biopsies, dialysis access procedures and transplant follow-up.
The need is growing: the <u>CDC</u> estimates that about 14% of US adults live with chronic kidney disease. Nevada Medical Billing Services runs the full revenue cycle for Nevada nephrology practices, so the expanding demand for kidney care becomes dependable revenue rather than an expanding backlog.
Nephrology rarely loses money through dramatic denials. It loses it quietly, through claims that pay less than they should and services that are never billed at all.
Your nephrologists, partners and nurse practitioners round at several dialysis units. When the biller sees only the managing physician's notes, a month that supports 90960 goes out as 90961. No denial ever arrives; the practice is simply paid less, every month, for every undercounted patient.
During the 30-month ESRD coordination period, an employer group health plan pays before Medicare. Bill Medicare first and the claim denies with CO-22, then waits while the patient's coverage history is untangled.
A separate office visit for routine dialysis-related care is already paid inside the MCP and denies with CO-97. A visit for an unrelated problem is billable, but only with a distinct diagnosis and clear documentation.
N18.9 or N18.30 on a chart that documents a GFR supporting stage 3b, or N18.6 without Z99.2 for a patient on dialysis, invites rejections and weakens medical necessity for every related service.
Kidney disease education for stage 4 patients, G2211 on ongoing CKD visits, principal care management and blood-pressure remote monitoring are all legitimate, documented services that most nephrology practices perform and never bill.
The Monthly Capitation Payment (MCP) is the financial backbone of a dialysis practice. We treat it as its own workflow, with a reconciliation built for multi-unit rounding.
| Patient situation | Codes (adults 20+) | What determines the code | What we reconcile |
|---|---|---|---|
| In-center dialysis, full month | 90960 / 90961 / 90962 | 4+, 2-3 or 1 face-to-face visits | Every visit by every physician, NP and PA across all units |
| Home dialysis, full month | 90966 | Age, plus a monthly face-to-face assessment | Monthly assessment documented, in person or via eligible telehealth |
| Partial month (transient, hospitalized, transplanted) | 90970 per day | Days under your outpatient care | Day count matched to admission and transplant dates |
| Pediatric patients | 90951-90959, 90963-90965, 90967-90969 | Age band and visit count | Age at date of service |
Medicare allows one MCP per patient per calendar month, billed by the physician who performs the complete assessment. We close each month with a visit log reconciled against every unit's schedule, so nothing is undercounted and nothing is billed twice.
We verify coverage before every visit and again at the start of each dialysis month, track Medicare entitlement and 30-month coordination dates, and secure authorizations for biopsies, imaging and specialty drugs.
AAPC and AHIMA-certified coders assign CPT, ICD-10-CM and HCPCS codes with full CKD staging, combination codes for hypertensive and diabetic kidney disease, and correct status codes.
We build a monthly charge-capture workflow for every dialysis unit, hospital and office your nephrologists cover, so inpatient dialysis, consults and MCP visits all land in the right place.
We bill ESAs and IV iron for non-dialysis CKD with correct units, hemoglobin documentation and modifiers, and support secondary hyperparathyroidism management.
ERAs and EOBs are posted daily and compared against contracted rates. Underpaid MCP months and procedures are appealed, not accepted.
Every denial is worked within 48 hours, root-caused and fixed upstream so it does not repeat.
Dialysis patients face lifelong costs. Clear statements, coordinated secondary billing and compassionate payment plans protect their trust in your practice.
We manage CAQH, PECOS, Noridian, Nevada Medicaid and commercial enrollment, report KPIs by physician and unit, and support MIPS and value-based kidney care reporting, including Kidney Care Choices participation.
| Scenario | Physician codes | Rule we enforce |
|---|---|---|
| CKD office visit | 99202-99215 + G2211 | MDM or time support; G2211 for ongoing CKD management |
| Acute kidney injury dialysis | 90935 / 90937 or E/M by site | Never billed with MCP codes; N17.- diagnosis |
| Inpatient dialysis | 90935, 90937, 90945, 90947 | Same-day E/M only for a distinct problem with modifier 25 |
| Home dialysis training | 90989 / 90993 | Reported apart from the MCP |
| Kidney biopsy | 50200 + 76942 | Imaging guidance documented separately |
| Dialysis access | 36901-36909, 36556 / 36558, 93990 | One base code per circuit session; catheter type documented |
| Kidney disease education | G0420 / G0421 | Stage 4 CKD, referral, up to 6 lifetime sessions |
| Care management | 99490-99491, 99424-99427, 99453-99458 | Consent, time thresholds, no overlap with MCP-covered work |
| Transplant follow-up | E/M with Z94.0, T86.1- | MCP stops at transplant; per-day codes for days before surgery |
Code families are representative; every claim is coded to current-year CPT and CMS rules.
| Denial code | What it means | Typical nephrology trigger | How we prevent it |
|---|---|---|---|
| CO-22 | Another payer is primary | Medicare billed first during the 30-month coordination period | MSP status and coordination dates tracked per patient |
| CO-97 | Bundled service | Routine dialysis-related E/M billed in an MCP month | MCP scope review before any separate E/M |
| CO-11 | Diagnosis inconsistent | N18.6 without Z99.2; unspecified CKD stage | CKD staging mapped from the documented GFR |
| CO-151 | Units or frequency exceeded | Two MCP codes for one patient in one month | One MCP per patient per month enforced |
| CO-50 | Not medically necessary | Labs, ESAs or ultrasound without supporting diagnosis | Diagnosis linkage checked against LCDs |
| CO-16 | Missing information | Missing hemoglobin value, NDC or referring provider | Pre-submission documentation checklist |
| CO-29 | Timely filing expired | Late MCP claims from unreconciled months | Month-end close calendar with filing deadlines |
No migration and no new software. Our team works directly in your EHR and practice management system under a signed BAA, including Epic, Oracle Health (Cerner), athenahealth, eClinicalWorks, NextGen, AdvancedMD and Tebra, and alongside nephrology-specific platforms and dialysis unit records. We map each unit, build the monthly MCP reconciliation, and keep it running whether your nephrologists chart on desktop or mobile.
We review 90 days of claims, denials, MCP months and A/R to find revenue leakage.
BAA, EHR access, EDI and ERA enrollment, fee schedule review and a dedicated account manager.
Every dialysis unit, hospital and office mapped into the monthly charge-capture workflow.
Eligibility, coordination of benefits and authorization before every service and every dialysis month.
Certified coders code from signed notes within 24-48 hours; MCP months closed after reconciliation.
Daily posting, underpayment checks and A/R follow-up by aging bucket.
Root-cause fixes and a monthly KPI review by physician and unit.
National vendors treat Nevada as a dropdown. We work Nevada payer rules every day.
We follow Noridian's billing requirements for MCP date spans, dialysis services and kidney-related LCDs, and manage Medicare Advantage plans with their own authorization rules.
We handle Nevada Medicaid fee-for-service and managed care claims, dual-eligible crossovers and plan-specific authorization rules.
Anthem Blue Cross Blue Shield Nevada, Health Plan of Nevada and UnitedHealthcare, Prominence Health Plan, Hometown Health, Aetna, Cigna, TRICARE, and the employer group health plans that pay first during ESRD coordination.
Las Vegas, Henderson, Summerlin, North Las Vegas, Reno, Sparks and Carson City, supported on Pacific Time during your clinic hours.
| Factor | In-house billing team | Nevada Medical Billing Services |
|---|---|---|
| Cost | Salaries, benefits, training, software, turnover | One percentage of collections; we earn only when you are paid |
| MCP visit reconciliation | Often one person's spreadsheet | Monthly reconciliation across every unit before claims go out |
| Coordination of benefits | Discovered through CO-22 denials | MSP and 30-month dates tracked for every ESRD patient |
| Coverage during PTO or turnover | Billing stalls | Continuous, with backup billers |
| Denial follow-up | When time allows | Within 48 hours, root-caused |
| Reporting | Whatever the PM system exports | KPIs by physician, unit and payer |
Stop losing evenings to MCP spreadsheets. We become your full billing department for less than the cost of one experienced nephrology biller.
Unit-level charge capture, one reconciled MCP per patient per month, and reporting by physician and facility.
Home dialysis assessments, training codes, partial months and transplant transitions billed without gaps.
Combined practices get primary-care and kidney-care billing under one team, with clean separation of MCP-covered and separately billable work.
Every coder on your account holds AAPC or AHIMA credentials and codes kidney care every day.
We run your account to a 95%+ clean claim rate, 96-99% net collection rate, denial rate under 5% and fewer than 35 days in A/R. Practices that start reconciling MCP visits and billing unclaimed services commonly see collections rise 10-15% within six months.
One named contact, a direct line and a monthly review call. No ticket queues.
Signed BAA, role-based access, encrypted systems and pre-bill audits that keep you ready for payer or OIG review.
Month-to-month with 30 days' notice. We keep your business by performing, not by locking you in.
Our pricing is a percentage of collections, typically 4-7% for nephrology practices, based on claim volume, number of dialysis patients, payer mix and the services you need. No setup fees, no hidden charges, and you pay only on money we collect. We confirm your exact rate after a free audit.
HIPAA compliant · Signed BAA · No obligation
In a free 30-minute audit, we review your MCP visit counts, coordination-of-benefits denials, unbilled services and A/R aging, then show you exactly where revenue is leaking and what it is worth to recover.
Free 30-minute review · No obligation · HIPAA compliant with signed BAA
Internal medicine billing servicesPrimary care billing servicesCardiology billing servicesNeurology billing servicesEndocrinology billing servicesGastroenterology billing servicesNephrology billing services include eligibility and coordination-of-benefits checks, CPT and ICD-10 coding, ESRD monthly capitation reconciliation, claim submission, payment posting, denial management, A/R follow-up and patient billing. Nevada Medical Billing Services also manages credentialing and value-based care reporting.
Nephrology billing is complex because most dialysis revenue comes through one monthly capitation code driven by visit counts across several units, while many patients carry Medicare plus an employer plan that must be billed in the right order. CKD staging and bundling rules add further risk.
Medicare pays the managing nephrologist one monthly code per dialysis patient. For in-center adults, 90960 covers 4 or more face-to-face visits, 90961 covers 2-3 and 90962 covers 1; home dialysis adults bill 90966, and partial months use 90970 per day.
Yes, but only for a problem unrelated to ESRD and dialysis management, with a distinct diagnosis and clear documentation. Routine dialysis-related care is already paid inside the MCP and is denied as bundled if billed separately.
It is the window when an ESRD patient's employer group health plan pays first and Medicare pays second. Billing Medicare as primary during that window causes CO-22 denials, so coordination dates must be tracked for every patient.
AKI patients do not have ESRD, so MCP codes never apply. The nephrologist bills each encounter with 90935, 90937 or an E/M code for the setting, plus an N17 diagnosis, while the dialysis facility bills its own AKI codes.
Yes. Medicare Part B covers up to six lifetime kidney disease education sessions for patients with stage 4 CKD who are referred by the managing physician, billed with G0420 (individual) or G0421 (group).
The most common nephrology denials are CO-22 (wrong primary payer), CO-97 (service bundled into the MCP), CO-11 (diagnosis inconsistency such as missing Z99.2), CO-50 (medical necessity) and CO-29 (timely filing). Each traces back to a fixable workflow gap.
Outsourcing usually costs less than an in-house team once salaries, benefits, software and turnover are counted, and it brings systematic MCP reconciliation and coordination-of-benefits tracking. In-house can work for large groups with two or more experienced nephrology billers.
Most nephrology billing companies charge a percentage of collections, commonly 4-7%, depending on volume, dialysis census, payer mix and services. Nevada Medical Billing Services confirms a flat percentage after a free audit, with no setup fees.
Yes. We bill Medicare through Noridian (Jurisdiction F), Medicare Advantage plans, Nevada Medicaid and its managed care plans, dual-eligible crossovers and Nevada commercial payers such as Anthem BCBS Nevada and Health Plan of Nevada.
Onboarding typically takes 2-3 weeks, mostly waiting on payer EDI and ERA approvals. During that time we map your dialysis units, build the MCP reconciliation and load fee schedules, and we agree in writing who works your existing A/R.