Nephrology RCM Solutions

Nephrology Billing Challenges

Nephrology billing is one of the most complex areas in healthcare. Monthly Capitation Payments (MCP) for dialysis patients, the distinction between ESRD and non-ESRD services, and the unique modifier requirements for dialysis-related procedures require deep specialty knowledge to bill correctly.

HeavenRCM's nephrology team understands the CMS ESRD bundling rules, composite rate calculations, and how to properly bill for separately billable items that fall outside the MCP — recovering revenue that most billing companies miss.

Services We Optimize

• Monthly Capitation Payment (MCP) management
• Hemodialysis & peritoneal dialysis billing
• Dialysis access procedures (fistula, graft)
• Kidney biopsy coding
• Transplant evaluation & post-transplant care
• CKD staging & chronic disease management
• Hospital rounding & inpatient consults
• Separately billable labs & medications (ESRD PPS)

Common Codes We Optimize