Nephrology Medical Billing Services

Separate physician work from facility accounts

We ask how the practice records office and hospital services, where charges originate and which entity is responsible for each claim. A dialysis facility's bundled payment is a different workflow from the physician group's professional billing.

For Medicare dialysis-related professional care, monthly reporting arrangements can apply. The assessment identifies the care setting and source records rather than treating each encounter as an independent office claim.

Reconcile the period and provider handoffs

For an accepted dialysis-related scope, we need the practice's process for tracking the relevant service period, provider coverage and supporting visit information. Changes of setting or responsibility should reach billing through a defined handoff.

Missing records and ambiguous responsibility are returned to the practice before a claim is released or corrected. We do not infer services from a patient roster alone or assume a facility's records establish the physician's billable work.

Work unpaid claims with the right account history

We can assess claim exceptions, remittance posting and payer follow-up for the professional scope. Available submission history, denial reasons and prior notes help determine whether the next action belongs with the payer, the practice or another billing entity.

Reports should distinguish unresolved billing questions from payments and approved adjustments. Facility operations and system-wide dialysis revenue cycle services are not silently included in a physician-practice engagement.

What to discuss first

• Office, hospital and dialysis-related professional services requested.
• Physician group and separate dialysis-facility responsibilities.
• Source records and the service-period reconciliation process.
• Existing billing system, access and main unresolved claim issues.

Common questions

Billing references: CMS physician and facility ESRD claim instructions.