Your kidney care is complex. Your billing shouldn’t cost you. HelloMDs fixes it with certified nephrology billing experts, 99% first-pass accuracy, handles ESRD, dialysis, CKD, and transplant billing, so you collect every dollar you earn.
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One wrong MCP code across your ESRD panel costs you thousands every month, silently. In 2026, the ESRD PPS base rate sits at $281.71, but missing patient adjusters, incorrect wage index application, or mismatched visit counts pull your actual reimbursement far below that figure. Add Modifier JW/JZ enforcement, dialysis bundle compliance, and updated telehealth rules, and generic billing teams cannot keep up.
HelloMDs places AAPC-certified nephrology billing specialists directly on your claims. We handle ESRD capitation, dialysis coding, CKD staging, and vascular access billing with the precision this specialty demands, so you treat patients while we protect your income.
Nephrology practices in 2026 face increasing revenue leakage from coding, compliance, and payer system complexity.
MCP Coding Errors - Selecting CPT 90960, 90961, or 90962 incorrectly based on visit count or patient age costs significant capitation revenue across your entire ESRD panel every month.
Prior Authorization Failures - The ESRD PPS bundles medications, labs & supplies into one per-treatment payment. Billing outside the bundle without justification triggers CMS denials and 2026 compliance scrutiny.
Modifier JW/JZ Gaps - CMS now requires Modifier JW (drug waste) or JZ (zero waste) on every single-dose injectable claim. Missing either causes automatic rejection, a hidden denial driver most practices never catch.
CKD Documentation Failures - CKD staging codes N18.1-N18.6 require precise, consistent documentation. Unspecified or mismatched staging flags claims for payer review and delay reimbursements across your full patient panel.
We manage your complete nephrology revenue cycle with specialty-trained coders and 2026-aligned billing workflows, from first encounter to final payment.
We select CPT 90960 (adults, 4+ visits), 90961 (2-3 visits), and 90962 (1 visit) based on confirmed age and face-to-face visit count. Every claim includes documented dialysis adequacy (Kt/V or URR) and monthly visit logs per 2026 CMS requirements. ICD-10: N18.6, Z99.2.
We bill hemodialysis (CPT 90935, 90937) and peritoneal dialysis (CPT 90945, 90947) with full ESRD PPS bundle compliance. Our team audits all bundle inclusions before submission, preventing outside-bundle billing that triggers CMS scrutiny at the 2026 base rate of $281.71.
We code CKD stages precisely using N18.1-N18.6 and pair them accurately with hypertensive CKD (I12.x) and diabetic nephropathy (E11.65). Correct comorbidity coding supports medical necessity and protects long-term reimbursement across your chronic kidney care panel.
We manage CPT 36818-36834 with correct Modifier 59 or XS when performed on the same day as dialysis. We document clinical necessity on every claim, preventing same-day bundling denials that go unresolved without specialty billing expertise.
We bill tele-nephrology with Modifier 95 under active 2026 CMS-approved rules only. We enforce one critical compliance rule: TCM codes 99495 and 99496 are never billed in the same month as a full MCP by the same provider, a conflict silently costing practices thousands in recoupment.
Our certified nephrology specialists handle ESRD, dialysis, CKD staging, and vascular access coding accurately on every claim we submit.
We submit clean claims correctly the first time, reducing rework, accelerating payer processing, and protecting your practice from audit exposure.
Every nephrology claim and patient record is handled under full HIPAA compliance, protecting your practice from data risks at every billing stage.
We identify root causes, correct coding issues immediately, and resubmit fast, reducing your denial rate by up to 15% within 90 days.
Live dashboards show A/R days, net collection rates, and first-pass ratios so you always know exactly where your revenue stands.
01
Correct ESRD capitation code selection every time protects per-patient revenue across your full monthly billing cycle.
02
Clean, documentation-complete claims reach payer approval faster, shortening your A/R cycle and improving monthly cash flow.
03
Precise CPT, ICD-10, and modifier application drives your nephrology denial rate below 5% on every submitted claim.
04
Every claim aligns with updated ESRD PPS rules, Modifier JW/JZ requirements, and Physician Fee Schedule efficiency adjustments.
05
We handle prior authorizations, eligibility verification, and payer follow-ups so your staff focuses entirely on patient care.
| Challenges | Solutions |
|---|---|
| Wrong MCP Code | We verify patient age and monthly visit count before billing CPT 90960 to 90962, protecting your full ESRD capitation payment every month. |
| Dialysis Bundle Violations | Our team audits every ESRD PPS claim for bundle inclusions before submission, preventing outside-bundle billing that triggers immediate CMS denials. |
| Missing JW/JZ Modifiers | We append Modifier JW or JZ on all single-dose injectable claims before submission, preventing automatic rejections under 2026 CMS edit requirements. |
| CKD Staging Errors | We code CKD stages N18.1-N18.6 precisely, eliminating unspecified codes that increase payer scrutiny and delay reimbursements practice-wide. |
| TCM and MCP Conflicts | We ensure TCM codes 99495 and 99496 are never billed in the same month as a full MCP code by the same provider, a 2026 compliance requirement. |
| Vascular Access Denials | We apply Modifier 59 or XS correctly and document clinical necessity on every vascular access claim to prevent same-day dialysis bundling denials. |
Nephrology billing is too code-specific and compliance-heavy for a general billing service. HelloMDs brings AAPC-certified coders, nephrology-focused workflows, and 2026-compliant ESRD billing expertise directly to your practice. From MCP coding errors and dialysis bundling issues to missing JW/JZ modifiers and telehealth compliance gaps, we quickly fix billing problems and recover lost revenue.
CPT 90960 (adults, 4+ visits), 90961 (2-3 visits), and 90962 (1 visit). Pediatric codes run 90951-90959. Selecting the wrong code based on visit count is the most costly nephrology billing error.
$281.71 per dialysis treatment, a 2.2% increase from 2025. Incorrect wage index application or missing patient adjusters reduces actual reimbursement significantly below this figure.
JW = drug waste from a single-dose vial. JZ = zero waste. CMS requires one on every single-dose injectable claim in 2026. Missing either triggers automatic rejection.
No. CMS prohibits TCM codes 99495 or 99496 in the same month as a full ESRD MCP by the same provider, a rule that frequently causes unexpected denials.
Yes, across all 56 U.S. states and territories, following both federal CMS guidelines and state-specific payer policies on every claim.
Yes. We bill hemodialysis (CPT 90935, 90937), peritoneal dialysis (CPT 90945, 90947), and vascular access procedures (CPT 36818-36834) with correct modifiers, bundle compliance, and clinical necessity documentation on every claim.
Most practices see a measurable denial rate reduction within 60 to 90 days. Our team identifies root causes immediately, corrects coding errors, and resubmits outstanding claims to recover lost revenue quickly.
