Specialized Nephrology Billing Solutions
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
Overview of Nephrology Billing Services
More than 35.5 million Americans, or 1 in 7 US adults, have chronic kidney disease (CKD). Sadly, only 4,532 nephrology practices are operating to provide kidney care countrywide. It means that nephrologists are working at optimal capacity to prevent, treat, and manage renal diseases. They are in dire need of reliable nephrology billing partners to take over the financial aspects of their practice.
MediBill MD’s suite of nephrology billing services includes the following to streamline the billing workflow and optimize revenue growth.
- Eligibility Verification
- Medical Coding
- Claims Processing
- A/R Recovery
- Denial Management
- Payment Posting
- Credentialing
Common Challenges in Nephrology Medical Billing
Medical specialties with a claim denial rate of over 10% are considered to be in the “denials danger zone”. Unfortunately, nephrology is one of those specialties with an average denial rate of 14%. Nephrology medical claims are typically denied because of coding errors, insufficient documentation, non-compliance, or billing uncovered services and procedures. It adds to the woes of nephrology practices that are already struggling because of payment cuts, staff shortages, and ever-changing regulations.
However, by understanding the common challenges in nephrology medical billing, providers and their in-house billing teams can mitigate denials and take the necessary steps to boost revenue.
Inaccurate Coding
CPT, ICD-10-CM, and HCPCS coding systems are the backbone of nephrology billing. Providers must code each consultation, diagnosis, treatment, and aftercare according to these coding guidelines for reimbursement collections. However, choosing the most appropriate codes from a list of hundreds is tough, and insurance payers reject inaccurately coded medical claims.
Regulatory Non-Compliance
Nephrology billers and coders must abide by federal/state laws and meet government and private insurance payers' rules and requirements when submitting claims, collecting reimbursements, or appealing denials. It is because, like all medical specialties, nephrology medical billing is heavily regulated, and non-compliance can result in legal actions.
Inadequate Documentation
Nephrology practices’ medical claims are often denied because of a lack of documentation. When providers fail to submit supporting documents, such as the history of illness, referral letters, clinical notes, etc., to prove the medical necessity of a service or procedure, payers deny the claim to save on capital.
Aging Accounts Receivables
The accounts receivables (AR) days in nephrology billing are usually high. The number indicates that the provider was unable to collect outstanding payments for months. Aging AR reduces the chances of collection, hurts cash flow, and brings the revenue cycle to a standstill. It also leads to bad debts.
Outsource Nephrology Billing Services to MediBill MD
The rates of renal diseases are expected to rise in the coming years as the share of older adults increases in the US population. Nephrologists are central to preventing and treating kidney diseases. However, they cannot render quality kidney care if heaps of paperwork, claim submissions, and payment tracking occupy them for hours each day.
Outsourcing nephrology billing services to professionals like MediBill MD takes the non-clinical load off nephrologists and ensures they are single-mindedly devoted to patient care. Here, at MediBill MD, we carefully study the billing needs of our clients and delegate the best medical coders, billers, and revenue cycle managers to the account to ensure speedy recoveries and optimal cash inflow.
At MediBill MD, we employ a team of AAPC-certified professional coders and medical billing experts who are proficient in handling the intricacies of nephrology medical billing. Their industry knowledge and mastery of the CPT, ICD-10, and HCPCS coding standards ensure clean claim filing, maximized reimbursements, and streamlined workflow.
We wear our HIPAA-compliant and ISO certifications like a badge of honor. Besides ensuring regulatory compliance in data security and service quality, we stay abreast with the insurance payers’ changing policies. It helps us adapt our billing workflow to meet the government and payer requirements and avoid surprise inspections.
At MediBill MD, we believe in harnessing the potential of human-tech collaboration. Our nephrology billing solutions are powered by advanced software and hardware to automate repetitive and rule-based tasks, ensuring quick turnarounds. At the same time, human experts run quality checks at each step to ensure high quality and accuracy.
We assign dedicated account managers to each of our clients, enhancing efficient communication to mitigate errors and risks. Apart from weekly consultations and follow-ups, we generate detailed monthly reports to track the practice’s financial performance and identify areas of improvement. We act as the bridge between our clients and insurers.
Unrestricted by state boundaries, unlimited by distance! At MediBill MD, we leverage remote operability and virtual systems to deliver nephrology billing excellence countrywide. It doesn’t matter where your nephrology center or private practice is located. Our certified professional coders and medical billing experts use their deep understanding of local regulations and industry guidelines to file clean claims, fight denials, and foster revenue.
Overcome Nephrology Billing Challenges with MediBill MD
The Centers for Medicare and Medicaid Services (CMS), as well as private insurance payers, deny medical claims that do not meet their coding guidelines and billing requirements. Frequent claim denials can cost a practice more than they bargained for. But at MediBill MD, we take a proactive approach to avoiding nephrology billing pitfalls. It helps us file clean and compliant claims for higher and timely reimbursements.
| Common Nephrology Billing Challenges | MediBill MD Solution | |
|---|---|---|
| Medicare’s Consolidated Billing Rules for End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) | Our team knows Medicare’s rules for bundled billing for ESRD patients’ dialysis. They use the AY modifier appropriately to collect a separate payment if the provider is a non-ESRD facility. | |
| Incorrect or Missing N18 Codes when Diagnosing ESRD and Chronic Kidney Disease (CKD) | We understand that the N18 series in the ICD-10-CM coding system specifies the stage of ESRD and CKD. Hence, we assign the correct code when billing the diagnosis and treatment. | |
| Insufficient Documentation to Explain the History of Present Illness | Our nephrology billing team maintains complete and accurate documentation to report signs, symptoms, diagnosis, and treatment of the present disease. It helps explain the medical necessity of rendered services. | |
| Improper or Hasty Patient Eligibility and Insurance Benefits Verification | We thoroughly verify each patient’s insurance coverage during patient scheduling to avoid denials later. Appointments are given after we have confirmed the eligibility and benefits or sought prior authorization. | |
| Not Following Medicare’s Transitional Drug Add-on Payment Adjustment (TDAPA) Rule for Administering New Renal Dialysis Drugs | Medicare allows ESRD facilities to use and bill new drugs and equipment for renal dialysis. We follow Medicare’s requirements to collect add-on payments on top of ESRD PPS base rates. | |
Lowest Prices Guaranteed
Enjoy a flat 1% promo rate on all nephrology billing services! Partner with MediBill MD and pay as low as 1% of your net collections for the first month of service. Ensuring low-risk, high-rewards.
Get In Touch with Our
Nephrology Billing Experts
Instead of struggling, leave the non-clinical aspects of your practice in the capable hands of our nephrology billing experts. Reach out to us for a free consultation and service demo.
FAQs
MediBill MD’s comprehensive nephrology billing services are designed to deliver medical coding and billing accuracy and efficient practice management at the lowest possible monthly rates. By choosing MediBill MD as your nephrology billing partner, you get affordable, customized, and compliant billing solutions for an optimized revenue cycle.
Outsourcing nephrology billing services to MediBill MD is more cost-effective than setting up an in-house billing department. With our promo deal, you can acquire professional nephrology billing services for as low as 1% of gross monthly collections for the first month of service. After that, the pricing structure will be reset to 2-5% of net collections.
Coding is the biggest challenge in nephrology medical billing. Besides staying up-to-date with the latest CPT and ICD-10 coding guidelines, nephrologists must also ensure accurate renal failure and chronic kidney failure coding. Moreover, the assigned codes must be backed by adequate documentation to support the medical necessity of procedures and services.
