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Nephrology Billing Services
Nephrology billing treats dialysis-related claims and monthly capitation codes as what they are — not an office visit. Vector Medical Billing, in Jamaica, New York, matches MCP visit counts, keeps inpatient dialysis outside the monthly payment, separates AKI from ESRD, and runs CKD clinic E/M inside the EHR you already use.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Monthly fee
What nephrology billing services include
Full-cycle RCM for nephrology clinics and dialysis physician groups — CKD office panels and ESRD monthly capitation on one account when that is how you practice.
The operating cycle matches medical billing services: eligibility, charge capture from clinic notes and dialysis visit logs, ICD-10 / CPT / HCPCS coding, scrub, clearinghouse submission, payment posting, denial management, and A/R follow-up. The scrub watches MCP age and face-to-face visit count, one-MCP-per-month uniqueness, home vs in-center families, partial-month per-diem units, inpatient dialysis outside MCP, and AKI vs ESRD diagnosis pathways.
In scope: CKD and transplant-evaluation clinic E/M, outpatient ESRD MCP (90951–90962 by age and visit count), home dialysis MCP (90963–90966), partial-month / transient per-diem ESRD codes (90967–90970), inpatient hemodialysis and related professional dialysis codes when performed, and non-renal same-day E/M with modifier 25 when documented. Facility ESRD PPS and dialysis-center technical billing are not the clinic percentage — those stay with the facility or a separately scoped account. Inpatient day codes for a dedicated hospitalist group sit on hospitalist billing when that is a different account.
The fee is a percentage of net collections. The written rate is on pricing. Credentialing, a retrospective coding audit, MIPS, and out-of-network / IDR stay separate engagements.
What sits on this nephrology fee
- MCP and dialysis lines kept off the office-visit code set when they belong on MCP
- Visit counts, partial months, and AKI/ESRD split watched before claims age
- HIPAA workflows, a signed BAA, and PHI limited to staff on the account
Where nephrology claims fail
Patterns CMS MCP RAC topics and dialysis NCCI guidance keep naming on ESRD panels.
MCP billed as 99214
Dialysis-related monthly physician services coded as ordinary office visits — or stacked with a second MCP from another practitioner in the same month. MCP is one payment per patient per calendar month from the responsible practitioner, billed after the month ends with a date span and unit of one.
Visit count in the note must support 4+, 2–3, or 1 face-to-face encounter for the adult outpatient family.
Renal E/M + dialysis same day
Hemodialysis procedure codes include E/M related to the dialysis and renal failure that day. Hypertension, fluid overload, uremia, and electrolyte work tied to that dialysis are not a separate office or hospital E/M on the same date. Unrelated significant E/M may use modifier 25 when documented.
NCCI Chapter 11 is explicit — related renal E/M does not unbundle.
Inpatient left inside MCP — or AKI as ESRD
Inpatient dialysis and inpatient ESRD-related visits are outside outpatient MCP and bill separately. AKI dialysis is not an ESRD MCP month. Partial months from hospitalization, transplant, or travel often need per-diem units instead of a full MCP — or a documented full MCP when assessment and visit rules are still met.
Wrong pathway is a RAC and denial pattern, not a minor edit.
MCP · not an office visit
Dialysis MCP — not an office visit
Hub language made operational: monthly capitation is its own code family.
Outpatient ESRD monthly capitation covers dialysis-related physician services across the calendar month in outpatient settings (dialysis unit, observation, ED, home as applicable). Adult codes commonly cited: 90960 (4+ face-to-face visits), 90961 (2–3), 90962 (1). Pediatric MCP codes use age bands with the same visit-count logic (90951–90959 range). Age is determined at month end.
MCP includes nutrition assessment, dialysis modality and access evaluation, interdialytic management, and renal anemia monitoring among other dialysis-related work CMS bundles. It is billed once per month after the month concludes — not as a stack of 99213s for each chairside encounter.
MCP checklist
- One practitioner bills MCP per patient per month
- Documented face-to-face count matches the code level
- Date span for the month; units = 1; submit after month end
Home dialysis MCP and partial-month per diem
Full-month home codes vs daily units when the month is not complete outpatient ESRD care.
Home MCP 90963–90966
Home dialysis monthly codes are age-based full-month services. When the MCP physician completes a monthly assessment and at least one face-to-face outpatient visit in a month that also included hospitalization, a full home MCP may still apply under CMS examples — document the assessment and visit.
Do not also bill outpatient in-center MCP for the same patient-month.
Per diem 90967–90970
Less-than-full-month outpatient ESRD-related care — home partial months, transient patients, or partial responsibility days — uses age-appropriate per-diem codes with units equal to days of outpatient ESRD-related responsibility. Only the practitioner responsible for those days bills. Do not bill MCP and per diem for the same overlapping full-month story.
Transient vacation coverage is a classic per-diem scenario.
Inpatient dialysis and AKI vs ESRD
Different rails from outpatient monthly capitation.
Inpatient outside MCP
Inpatient services are not included in outpatient MCP. Hemodialysis with single or repeated evaluations (e.g. 90935 / 90937) and related inpatient ESRD visit codes bill on the hospital DOS. The inpatient physician and the outpatient MCP physician may both bill appropriately in a month that includes hospitalization — for different settings.
AKI is not ESRD MCP
Acute kidney injury dialysis follows AKI facility and physician pathways (facility often G0491 with AKI claim construction). Physicians use dialysis procedure codes when performed — not 90960-family MCP. Dropping ESRD MCP on an AKI-only patient is a compliance fail.
CKD clinic E/M
Non-dialysis CKD stages manage in the office with standard E/M, diagnosis specificity (N18.x), and medication/lab work. That is a true office visit — not MCP. Do not force dialysis monthly codes on CKD patients who are not on outpatient ESRD dialysis that month.
What MCP includes — and what can bill apart
Bundle awareness stops both undercoding and double billing.
Typically inside MCP
Dialysis-related outpatient physician services across the month: modality and access assessment, interdialytic management, renal anemia monitoring related to dialysis, diet/nutrition assessment tied to ESRD care, and preliminary transplant assessment elements CMS places in the monthly payment. Chairside dialysis-related encounters in the month feed the visit count — they are not separate 99214s.
Often outside MCP
Inpatient dialysis and inpatient ESRD visits; non-renal significant E/M with 25; complete renal transplant evaluation when separately reportable; certain immunizations (e.g. hepatitis B administration) per CMS exclusion lists; and facility technical dialysis under ESRD PPS. Confirm the current Medicare Claims Processing Manual Chapter 8 list before assuming an add-on.
Nephrology code families this service works
Illustrative anchors — age, visit count, and setting decide the final claim.
| Work type | Example | What to check | Common failure if skipped |
|---|---|---|---|
| CKD clinic E/M | 99202–99215 | Not on dialysis MCP that month | Forced MCP on CKD only |
| Adult outpatient MCP | 90960 / 90961 / 90962 | Face-to-face count; age; one/month | 99214 stack; duplicate MCP |
| Pediatric MCP | 90951–90959 | Age band + visit count | Adult code on child |
| Home MCP | 90963–90966 | Full-month home rules | In-center MCP same month |
| Partial / transient | 90967–90970 | Days as units; responsible MD | Full MCP + per diem overlap |
| Inpatient HD | 90935 / 90937 | Outside MCP; related E/M bundled | Renal E/M-25 same day |
| AKI dialysis | Procedure codes; not MCP | AKI diagnosis pathway | ESRD MCP on AKI |
| Unrelated E/M | E/M + 25 | Not renal-failure/dialysis related | 25 on bundled renal work |
This page does not invent a nephrology denial percentage. The free audit reads your MCP visit counts, partial months, and AKI/ESRD split on the sample you send.
What a free audit line looks like
Illustrative composite only — not a client result and not a promised recovery.
| Field | Example entry |
|---|---|
| Documented service | Adult in-center ESRD; four documented face-to-face dialysis-unit visits in March; hospitalized days 10–14 with inpatient HD by covering nephrologist; returned to outpatient for rest of month |
| Billed codes | Four separate 99214s for unit visits; no MCP; inpatient HD not billed |
| Issue found | Outpatient month should be MCP (likely 90960 if four qualifying visits); inpatient HD/visits bill separately outside MCP; office-visit codes misused for dialysis-related monthly care |
| Recommended correction | Bill age-appropriate MCP for outpatient portion after month end; inpatient physician bills 90935/related inpatient codes for hospital DOS; stop 99214 stack for MCP-included work |
| Related check | Only one outpatient MCP practitioner for March |
| Why it matters | Wrong code family plus missed inpatient professional dialysis — caught in scrub or flagged in the free audit |
Request a Free Audit with recent notes, claims, and denials. We map MCP vs office visit on your file — not this composite.
How Vector runs nephrology billing
Month-end MCP and setting first — then the same revenue cycle.
1
Assign nephrology
Coder and biller who already work MCP visit counts, home/per-diem, and AKI vs ESRD.
2
Reconcile and code
Charge entry and coding after month-end visit tallies — queries when count cannot be supported.
4
Post and report
835 posting, denial work, A/R aging, monthly RCM report by MCP vs clinic vs inpatient.
Not inside the nephrology percentage
Related work stays separate so the quote matches the job.
Facility dialysis PPS
ESRD facility technical billing under the PPS is the dialysis organization’s claim — not the physician MCP percentage on this page.
Credentialing / audit
Credentialing and a retrospective coding audit of MCP levels are separate engagements when scoped.
Underpay / OON
Underpayment recovery and OON / IDR stay separate when the dispute path is not ordinary denial work.
How nephrology billing is priced
Percentage of dollars that land — not a flat fee per chairside visit that ignores MCP.
Written rate
The fee is a percentage of net collections. No setup fee on the monthly cycle. Month to month. The written rate follows CKD clinic volume, dialysis census, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
What we need to start
EHR access, monthly CKD visit and dialysis census, home vs in-center mix, open A/R if you are leaving another biller, and a sample of recent MCP or dialysis denials. Switching usually overlaps so claim submission does not stop. See EHR integration if access setup needs a separate quote.
Audit the nephrology claims that treat MCP like an office visit
Send monthly CKD and dialysis census, home vs in-center mix, EHR name, and a sample of MCP denials. We reply with what the open A/R shows, whether the monthly fee fits, and a written rate — without inventing a clean-claim percentage.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Nephrology billing questions
Straight answers tied to the sections above.
What does nephrology billing include?
CKD clinic E/M, ESRD MCP by age and visit count, home and partial-month codes, inpatient dialysis outside MCP, AKI vs ESRD checks, scrubbing, submission, posting, denials, and A/R.
How much do nephrology billing services cost?
The fee is a percentage of net collections. No setup fee on the monthly cycle. The written rate follows clinic and dialysis census and payer mix.
Is the monthly capitation code an office visit?
No. MCP is a monthly dialysis-related physician payment — not a 99214. One MCP per patient per calendar month from a single billing practitioner.
What is billed separately from MCP?
Inpatient dialysis and inpatient ESRD visits, non-renal E/M with 25 when documented, and other CMS-listed exclusions such as certain complete transplant evaluations and vaccines when criteria are met.
How does AKI differ from ESRD MCP?
AKI dialysis is not billed with ESRD monthly capitation. Use AKI pathways and dialysis procedure codes — not 90960-family MCP for an AKI-only month.
Do we have to change our EHR?
No. Billers work in the system you already use — see EHR integration. Compatibility is confirmed before you commit.
Where does Vector provide nephrology billing?
The office is 15717 85th St, Jamaica, NY 11414-2620. Work is remote for nephrology practices in all 50 states. See the specialties hub.
Is Vector Medical Billing HIPAA certified?
HHS does not certify billing companies. Vector signs a BAA, limits PHI to staff on the account, and follows HIPAA workflows. A HIPAA security risk analysis is a separate engagement when scoped.