AI-Agentic Nephrology Billing Services
We Improve Your Finances With These Nephrology Billing Services:
- Full Compliance with HIPAA, Medicare, LCD, and NCCI rules
- AI-Powered Nephrology RCM from Scheduling to Collections
- Prevent Claim Denials by Using Accurate ICD-10, CDT, & HCPCS Codes
- Manage CKD, ESRD, and Renal Failure Billing with Precise Documentation
- Expertly Identifies & Addresses Claim Denials with Personalized Appeals
Why Your Practice Needs Professional Nephrology Billing Services?
Nephrology practices need professional billing services to overcome the following challenges:
Complex Nephrology Coding: CKD, ESRD, dialysis, and transplant services require precise CPT, ICD-10, and modifier usage to prevent costly coding errors.
Strict Documentation Requirements: Accurate clinical documentation is critical for renal failure staging, dialysis sessions, and comorbidity reporting to ensure proper reimbursement.
Authorization and Eligibility Delays: Dialysis treatments, procedures, and advanced diagnostics often require prior authorizations that can slow payments.
High Claim Denial Rates: Medicare regulations, NCCI edits, and bundling rules frequently lead to denials and reduced revenue if not managed correctly.
How Transcure Solves Nephrology Billing Challenges?
Nephrology practices need advanced medical billing support to handle complex coding and compliance rules. Here’s how Transcure supports your Nephrology practice’s financial success:
Dialysis & ESRD Billing Expertise
Our AAPC-certified coders apply correct billing rules for dialysis, ESRD services, and monthly capitation payments to ensure accurate reimbursement.
Faster Prior Authorizations
Transcure secures timely authorizations for dialysis treatments, interventional procedures, and high-cost nephrology services to prevent delays.
Medicare & Bundling Rule Management
We manage Medicare guidelines, NCCI edits, and bundling rules to avoid denials for nephrology procedures and same-day services.
Modifiers & Denial Prevention
Our experts apply appropriate modifiers and conduct proactive audits to reduce claim rejections and maximize nephrology revenue.
The Case Study of Idaho Kidney Institute Nephrology Billing Success with Transcure
Learn how Transcure automated nephrology billing operations of Idaho Kidney Institute and help them increase their revenue by 25%.
Our Success in Numbers
Value of claims processed
Accounts Receivable Days
Turn Around Time (TAT)
Customer Retention
Number of Claims Processed
First Pass Clean Claims Rate
Revenue Improvement
Reduction in A/R
Nephrology Billing Services with Nationwide Reach and Local Precision
Transcure offers specialized nephrology billing and coding services across the United States. Our remote operations enable us to serve nephrology practices nationwide, including the following states.
Why Choose Transcure for Billing Nephrology Services?
Transcure delivers customized nephrology billing solutions that simplify coding, reduce errors, and improve reimbursements. Below are the key reasons practices rely on Transcure for nephrology billing services:
Multi-Specialty Nephrology Billing
Transcure has expertise across billing multiple nephrology specialties, including transplant nephrology, pediatric nephrology, interventional nephrology, and hypertension-related kidney care.
Transparent Pricing
We offer percentage-based nephrology billing at 5% of monthly collections, which reduces in-house expenses by up to 30%.
Dedicated Account Manager
Transcure assigns a dedicated account manager who is available 24/7 to resolve issues and answer queries.
Supports Major Nephrology EHRs
Integrate with 40+ major nephrology EHRs, including eClinicalWorks, AdvancedMD, Athenahealth, Epic, and NextGen.
Compliance with Nephrology Billing Laws
Follow ESRD PPS, Medicare dialysis rules, QIP, and CMS guidelines for accurate nephrology billing.
Compliance with HIPAA Regulations
Our billing team strictly follows HIPAA rules to protect your patients’ health data throughout the billing cycle.
What Key Billing Services Does Transcure Offer for Nephrology?
At Transcure, we deliver specialized billing services to meet the unique needs of nephrology practices. Here are the key services we provide to simplify your revenue cycle and reduce denials:
AI-Powered Eligibility Verification
We verify patient dialysis, transplant, and CKD coverage in real time, checking Medicare, Medicaid, and commercial payer benefits, frequencies, and waiting periods using our ELIXA AI agent.
Automated Prior Authorization Management
With our PRIA AI agent, we handle pre-authorizations for dialysis sessions, interventional procedures, and kidney transplants to prevent treatment delays.
AI-Powered Nephrology Coding
Our certified coders, assisted by CODIN AI, review nephrology chart notes, lab results, and treatment plans to auto-assign precise CPT, ICD-10, and HCPCS codes.
Nephrology Insurance Contract Analysis
We analyze payer contracts, including Medicare, UnitedHealthcare, Cigna, Aetna, and Blue Cross, to identify underpayments and optimize reimbursements.
Real-Time Denial Detection
DEXA AI identifies denial trends for dialysis, transplant, and CKD-related claims, generating appeal letters and updating claim statuses in real time.
State & Payer-Specific Coding Rules
Track specific payer rules for dialysis, transplant, and nephrology procedures to prevent costly rejections and ensure compliant billing.
Does Transcure Follow Nephrology Billing Laws to Maximize Reimbursements?
At Transcure, we optimize nephrology reimbursements by strictly complying with federal and payer-specific regulations. Our nephrology billing experts follow key laws and programs, including:
- End-Stage Renal Disease Prospective Payment System: Ensures compliant bundled billing for dialysis services, medications, and related supplies.
- Physician Self-Referral Law: Prevents improper referrals for dialysis and renal services where financial relationships exist.
- Anti-Kickback Statute: Prohibits financial incentives linked to dialysis, transplant referrals, or renal care services.
- False Claims Act: Requires that all nephrology claims are fully supported by accurate documentation and demonstrate medical necessity.
What Nephrology Procedures Does Transcure Handle with Their Billing Services?
Transcure provides specialized nephrology billing support for high-cost procedures nationwide. Our nephrology billing experts handle every procedure, including but not limited to:
Hemodialysis
Peritoneal Dialysis
Kidney Transplant Evaluation
Kidney Transplant Surgery
Renal Biopsy
Vascular Access Placement
Interventional Nephrology Procedures
Continuous Renal Replacement Therapy
Ultrafiltration Therapy
Kidney Stone Removal Procedures
Hypertension-Related Kidney Procedures
Chronic Kidney Disease Management Consultations
Peritoneal Catheter Placement
Plasmapheresis
Kidney Function Testing
Electrolyte and Fluid Management Procedures
What Nephrology EHR Systems Are Supported by Transcure?
We work confidently across leading nephrology EHRs to optimize documentation flow.
How Nephrology Practices Benefit from Our Nephrology Medical Billing Services?
Explore the success stories of our partnered practices to see how our nephrology billing services help nephrologists improve revenue.
Jackie Judd
Practice Manager
Wilson Creek Internal Medicine
As a practice manager, I was looking to streamline the medical billing process. I tried other companies, but they were all complicated and took too much of my time. Fortunately, I found Transcure. They excel in tailoring solutions to fit my requirements.
Amber Vaughan
Office Manager
Idaho Kidney & Hypertension Institute
We are a large practice with 15 providers. Transcure has been working with us for the last 5 years. This billing company has been a great asset to us. I work with Transcure and they provide everything I ask for. The team is friendly and very pleasant to work with.
Ashlee Rose
Practice Manager
Harding Memorial Healthcare
We’ve been working with Transcure for 8 years now and I just wanted to say how happy we are with their services. They always get back to us quickly and are very easy to work with. They get my bills paid in record time and help us to generate millions in revenue.
Frequently Asked Questions (FAQs)
What are the most common CPT codes used in nephrology billing?
Nephrology billing frequently uses CPT codes for evaluation and management (E/M) visits, dialysis procedures, kidney biopsies, vascular access placements, and transplant services. Common codes include 90935, 90937, 90945, 90947, 36415, 50300, 50320, and 99213–99215 for outpatient visits.
What payer policies should nephrology practices watch for?
Nephrology practices should track Medicare ESRD rules, Medicaid coverage variations, commercial payer dialysis policies, prior authorization requirements, bundled payment guidelines, and any local coverage determinations (LCDs).
What should I look for in a nephrology billing company?
Choose a billing company that offers specialized nephrology expertise, certified coders, HIPAA compliance, EHR integration, denial management, and transparent pricing. They should also provide reporting dashboards, prior authorization support, and a dedicated account manager.
What should you ask before hiring a nephrology billing service provider?
- Do you charge any hidden or extra fees?
- Are there options for discounts or flexible payment plans?
- Does your team specifically specialize in nephrology medical billing?
- Is your billing operation fully HIPAA compliant?