Nephrology Billing Services Help-Driven Accuracy Maximizes Refunds
We at Sirius Solutions Global specialize in providing nephrology billing services suited to the specific needs of kidney care experts, dialysis facilities, and nephrology clinics. Our AI-powered medical billing software and experienced certified billers guarantee quicker claims processing, perfect coding, and maximum reimbursements while still being fully compliant with HIPAA.
97%
Client Retention
50+
Specialities
15%
Boost Revenue
35
States Served
Why Choose Our Nephrology Billing Solutions?
1. Understanding of certain nephrology codes
Complex nephrology codes include transplant surgery coding, ESRD (end-stage renal disease) billing, and dialysis session records.To reduce rejections, our licensed coders adhere to ICD-10, CPT, and HCPCS standards.
2. Technologies for Artificial Intelligence and Cloud-Based RCM
With your EHR, our cloud-based revenue cycle management solution fits flawlessly and provides:
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Predictive analysis applied for revenue projection trends
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Automated claim scrubbing prevents mistakes before submission.
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Following denial and the immediacy of resolving
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Faster payments depend on EFT, ERA, and EDI.
3. Understanding of dialysis and ESRD billing
Billing is easier for us since:
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Sessions on hemodialysis and peritoneal dialysis
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Monthly Capitation Payments (MCP)
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Home dialysis directions
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Maintenance of kidney transplantation
4. Technology-driven compliance and security
Your practice remains audit-ready while protecting sensitive patient data by way of HIPAA-compliant data encryption and AI-driven compliance monitoring.
Benefits of Partnering with Sirius Solutions Global for Nephrology Billing
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30% Faster Claim Turnaround with AI-powered claim scrubbing
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Up to 98% Clean Claim Rate reducing payment delays
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Improved Cash Flow through automated payment posting & follow-ups
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Custom Reporting Dashboards for financial transparency
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Dedicated Account Manager for personalized service
ESRD & dialysis billing essentials
Among the most rule-dense fields in medical billing are end-stage renal disease (ESRD) and dialysis charges. Small variations—whether an item is grouped under the ESRD prospective payment system (PPS), which CPT you choose for a dialysis appointment, or whether under the Monthly Capitation Payment (MCP), the patient is charged—can be the difference between a clean payment and an expensive denial or recovery. CMS specifically identifies the things and services included in an ESRD facility's bundled payment, and those standards are updated regularly; this is why. Clinics that treat ESRD patients need a billing partner that treats dialysis billing as a specialty, not a line-item exercise.
ESRD consolidated billing the practical impact
CMS’s ESRD PPS consolidated billing list includes many drugs, lab tests, supplies and supplies used during dialysis that are not payable separately when furnished to ESRD beneficiaries by providers other than the dialysis facility. In practice this means: don’t assume every injectable, lab, or supply related to dialysis is billable outside the facility — you must check the consolidated billing list for each patient encounter to avoid denials and recoupments. (CMS publishes an attachment listing items subject to consolidated billing each year — use it as your canonical reference when auditing claims.)
Key CPTs & billing notes
Below are the CPT families practices search for most — present these on your page as a short reference table and link each code to a deeper blog or PDF later:
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90935 / 90937 — hemodialysis evaluation and management sessions (single/repeated evaluations). These codes carry interpretation and procedure expectations that must match the clinical note.
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90945 / 90947 — peritoneal dialysis codes (single or repeated sessions). Accurate modality mapping matters for payment.
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90960 – 90962 (MCP / monthly ESRD-related services) — used when the patient qualifies for monthly capitation payment (frequency of visits drives CPT selection). MCP rules change by carrier and require specific documentation of face-to-face visits.
Important: include a short sentence under each code explaining the common documentation mistake you fix in real clinics — e.g., Common mistake: billing 90935 without documenting presence/medical necessity during the dialysis session.
The denials we see most — and how we stop them
We focus on the denial patterns that actually drain revenue for nephrology practices and give the exact operational fixes:
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Consolidated-billing denials (drug/lab/supply recoup)
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Root cause: item included in ESRD PPS was billed separately.
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Fix: automated consolidated-billing check at claim creation (compare item HCPCs against the latest CMS Attachment B) + pre-submission blocker for high-risk items.
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MCP misapplication or missing face-to-face documentation
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Root cause: MCP codes (90960 et al.) require specific visit counts and documentation.
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Fix: monthly MCP reconciliation, templated visit notes, and a prebill MCP validator.
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Modality mismatch (home vs in-center)
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Root cause: units billed don’t match documented modality (home training sessions vs in-center).
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Fix: modality flag in the scheduling/EHR + billing rule map to CPT sets (partial month logic included).
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Procedure/physician split errors (global vs professional component)
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Root cause: facility bills and physician bills overlap or miss the professional component.
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Fix: strict facility vs professional component mapping and daily charge audits.
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Listing these problems and exact solutions in plain language on the page helps practice managers find you and immediately trust your expertise — which improves both CTR and conversion.
Home dialysis & outpatient modality nuances
Home dialysis and partial-month care have separate code sets and documentation standards, including day/unit count rules and specific home-modality CPTs. Since home and in-center dialysis have distinct payment and billing procedures, we map modality per patient and monthly to balance claims and prevent underbilling or overbilling. Confirm local revisions before submitting using carrier-specific instructions and your MAC source (e.g., CGS/Noridian).
Trending Technology Features for Nephrology Practices
💡 AI-Powered Denial Management – Instantly finds claim hazards before submission with AI-powered denial management.
💡 Cloud-Based Patient Portals – Access protected for bills, statements, and payments is provided by cloud-based patient portals.
💡 EHR-Integrated RCM – Works with Epic, Cerner, Allscripts, Athenahealth, and more, EHR Integrated RCM.
💡 Automated CPT/ICD Mapping – Ensures coding accuracy for complicated nephrology procedures through automated CPT/ICD mapping.
💡 Predictive Analytics – Predictive analytics assists with projecting seasonal fluctuations in revenue and patient volume.
Quick Helpful Answers
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Partner with the Leaders in Nephrology Billing Excellence
Every minute spent pursuing claims takes away from patient care at Sirius Solutions Global. For all of these reasons, our AI-driven nephrology billing solutions are created to free you from the administrative burden, expedite reimbursements, and provide you total visibility into your financial results.
📞 Let's help you transform billing problems into predictable cash flow.
Get in touch with Sirius Solutions Global right now for a free revenue cycle study and witness how our nephrology billing specialists can help you to better your botto