We understand the specialty of nephrology, let us help you drive revenue and improve patient care.
Medical billing and coding for Nephrology practices can be complex.
Nephrology revenue cycle management is unique with daily dialysis, monthly capitation billing and a payor mix that contains a large amount of Medicare and Medicaid patients.
At Etransmedia we have narrowed our focus to the various rules and guidelines issued by the insurance carriers to assist our clients in streamlining their revenue and decreasing their rejections and denials. We have the knowledge and skills necessary to successfully work denials and provide our nephrologists with valuable feedback to assist in managing and decreasing the most frequently seen denial types, while streamlining revenue and increasing your practice’s collection rates. Collect every penny you deserve!
What we know…
Nephrology treatment ranges over a wide spectrum of diagnosis and may require extensive knowledge, testing and attention. Complicated ailments to diagnose and code for may include:
Chronic Kidney Disease (CKD)
Remove Excess Fluid
Remove Waste Products
Balance Different Minerals/Chemical
Assist with Vitamin D Production
Kidney disease occurs when there is damage to the kidneys that may or may not result in a lower than normal Glomerular Filtration Rate or GFR.
Chronic Kidney Disease or CKD is diagnosed when kidney damage exists for 3 or more consecutive months.
Causes of CKD
Here are some of the complications that are affecting Nephrology revenue collection procedure:
90935 (dialysis) is not payable with follow up 99231-99233 only Critical Care (99291)/Initial/Discharge
90935 (dialysis) is payable with critical care (99291-99292)/ initial (99221-99223) and discharge (99238-9); add modifier 25 to primary (non-dialysis) charge
36514- It is important to attach medically necessary code
Monthly (90960-3)DOS is last date of the month; or date of death
Daily/Visitors (90970) we bill the day before/day after treatment with quantity/date span
MediCal requires date span for all dialysis (08/01/2016-08/31/2016)
Nephrology however can enjoy quick accounts receivable turnover because of the large number of Medicare patients. If your practice is experiencing charge days in accounts receivable (AR / average days charges) that exceed 30 days you need to contact Etransmedia.
We can speed the time from service to payment and reduce your charge days in A/R. Contact us today to discuss how we can help.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
We’re always on top of all the latest coding and billing updates for nephrology practices. We make sure claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date on what is happening in their practice so any issues can be addressed quickly. Having an experienced medical billing team who understands nephrology, with visibility into performance, is vital to your practice’s financial health.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package