Revenue Cycle Management Services For Nephrology

Nephrology medical billing is an intricate specialty which requires a deep understanding of complex dialysis codes and administrative tasks. Renal care is difficult to bill because there are often prior illnesses or conditions, such as diabetes or hypertension, that can cause problems within the kidneys. Underlying health issues necessitate a comprehensive approach to billing, as they may involve multiple treatments and medications that need to be accurately documented and coded for insurance purposes. Urology treatments also commonly overlap in procedures that affect dialysis access, such as:

• Placement of peritoneal dialysis catheters (36556)
• Renal stone management in dialysis patients
• Urinary diversion surgeries

Urology’s role often complements nephrology through surgical intervention, particularly when patients have comorbid conditions like obstructive uropathy that complicate dialysis.

Medical Billing for Nephrology

The intricacies of nephrology billing require a detailed understanding of the specific codes and regulations that govern kidney-related treatments. Many providers attempt to handle nephrology billing internally. Even with a dedicated team, it's hard to avoid common errors including:

• Inaccurate Documentation: Failing to document all relevant details about dialysis procedures can lead to improper coding, missed reimbursements, or denials.
• Not Distinguishing Between Acute and Chronic Conditions: Codes for acute renal failure (ICD-10 N17) vs chronic kidney disease (CKD) (ICD-10 N18) need to be used correctly.
• Upcoding and Downcoding: Charging for more services than were provided (upcoding) or charging less (downcoding) can both result in audits or financial penalties.

Global’s nephrology specialists ensure every claim is fully optimized with the appropriate codes, modifiers, and documentation requirements—leading to higher reimbursement rates and fewer claim denials.

Medical Coding for Nephrology

Dialysis coding involves a mix of CPT codes, ICD-10 codes, and specific guidelines for various dialysis procedures—whether hemodialysis (CPT 90935-90999), peritoneal dialysis (CPT 90945), or dialysis access surgical procedures. Staying up to date with ongoing changes can be incredibly time-consuming.

Global’s experienced professionals will code dialysis procedures within 24 hours of submission and meet or exceed 95% accuracy rates. Let our skilled staff reduce denials and streamline your coding process.

Why Choose Global Healthcare Resource?

For more than 25 years, Global Healthcare Resource has been a leader in revenue cycle management for nearly every specialty, including nephrology. We proudly employ over 7,000 billing professionals, coders, and patient call center agents who undergo our rigorous internal training program, Global Academy. We believe a commitment to ongoing education results in our collective success. Global operates as an extension of your team. We integrate our services into your existing workflows to minimize disruption and ramp up quickly. Our services are tailored to your unique needs so we can deliver a truly customized partnership.

Schedule an Appointment to Start Nephrology Billing Outsourcing Today!