Nephrology Billing Services Powered by AI and Certified Coders
Transcure combines certified nephrology coding expertise with AI-driven checks to keep every claim accurate and compliant. Here is what our nephrology billing services deliver:
- 99.9% claims accuracy on CKD, ESRD, and dialysis claims via pre-submission checks.
- MCP and home dialysis coding matched to each month’s visit count and patient age.
- Medicare Secondary Payer and dual-eligibility checks by ELIXA before claims drop.
- CKD stage-specific coding (N18.1 to N18.6) checked against documented eGFR values.
- 24 days in A/R on average, with a 48-hour turnaround on every nephrology claim
Our Success in Numbers
Results vary by practice size, specialty and payer mix. Across Transcure clients, these are typical results:
Trusted by
500+ Physicians
Catering to
40+ Specialties
1100+ Certified
Medical Billers & Coders
End-to-End
RPA Billing Solutions
Up to 98% First Pass
Clean Claim Rate
Why Do Nephrology Practices Lose Revenue Without a Specialized Billing Company?
The AMA estimates up to 12% of medical claims carry inaccurate codes. Renal claims face extra risk from bundled ESRD payments, monthly capitation rules, and payer sequencing. Here are the five gaps we see most often in nephrology practices.
ESRD Monthly Capitation Errors
MCP codes 90951 to 90962 change with patient age and monthly visit count. A month with three visits billed as four or more triggers an overpayment and later recoupment.
Consolidated Billing Under ESRD PPS
Labs and drugs unrelated to ESRD need the AY modifier to get paid. Without it, Medicare treats the service as part of the dialysis bundle and denies it.
Medicare Secondary Payer Coordination
Group health plans stay primary during the 30-month coordination period. Billing Medicare first in that window leads to recoupments months after payment.
Unspecified CKD Staging
CKD claims need a stage-specific code from N18.1 to N18.6. Stage 3 now splits into N18.31 and N18.32, and N18.9 invites medical necessity denials.
Nephrology Practices That Have Put Trust in the Transcure Billing Team
Many nephrology practices have trusted the Transcure billing team for their revenue cycle management needs. Over the years, we have partnered with a wide range of providers, from small independent nephrologists to large multi-location renal care groups. Some of the prominent ones include:
What Nephrology Billing Services Does Transcure Offer?
Transcure covers every billable nephrology service, from the first CKD visit to post-transplant care. Our AI agents and certified coders handle in-center and home dialysis, ESRD monthly capitation, and vascular access coding. Each claim is coded from documentation, not defaults.
We also bill CKD office visits with G2211 where it applies, plus kidney transplant care and hospital rounding. Weekly charge reconciliation catches missed rounding visits before they turn into lost revenue. Credentialing and payer enrollment come first, so no claim stalls on an enrollment gap.
Our nephrology billing support includes
- Provider Credentialing and Payer Enrollment
- Patient Eligibility and Benefits Verification
- Prior Authorization Management
- Charge Entry and Charge Capture
- CPT, ICD-10, and HCPCS Coding
- Claim Scrubbing and Submission
- Payment Posting and ERA Reconciliation
- Denial Management and Appeals
- Accounts Receivable Follow-up
- Patient Statements and Revenue Reporting
How Does Transcure Handle Different Laws and Challenges Affecting Nephrology Billing?
Transcure assigns nephrology-trained billing specialists who track CMS rule changes, apply correct ESRD codes, and prevent compliance violations. Our nephrology medical billing services cover
ESRD Prospective Payment System
CMS bundles dialysis drugs, labs, and supplies into one per-treatment payment under the ESRD PPS base rate, proposed to rise to $299.55 for CY 2027 as phosphate binders fold into the bundle. Transcure's CODIN tool maps each service to its current bundled or separately billable status.
Dual-Eligibility Billing Errors
ESRD qualifies patients for Medicare regardless of age under 42 CFR § 406.13. Transcure verifies Medicare-Medicaid coordination of benefits through ELIXA before every claim drops, eliminating payer ID and sequencing errors at submission.
Documentation and Coding Gaps
CMS requires stage-specific ICD-10-CM codes N18.1 through N18.6 for CKD. Our nephrology billing team cross-checks physician notes against billed diagnosis codes and returns documentation deficiency alerts before claim release.
Stark Law and AKS Referral Protection
Stark Law and AKS violations carry penalties up to $34 million per DOJ enforcement data. Transcure audits your referral patterns quarterly. Flagged arrangements reach your legal counsel before claims drop.
How Transcure Helped the Idaho Kidney Institute with Their Nephrology Medical Billing?
Idaho Kidney Institute carried $300,000 in unpaid claims stuck in the 60+ bucket. Transcure’s billing team cut that backlog to $100,000 within 90 days. Denial rates dropped across every category with missing information, medical necessity, invalid ICD codes, and modifier errors.
Claims billed as self-pay to insured patients were caught, verified, and resubmitted to correct payers. Dr. Fahim Rahim called Transcure “more than a billing partner — a trusted ally.” Your nephrology practice faces the same denial patterns IKI did. The difference is how fast you act on them.
What Nephrology Sub-Specialties and Practices Does Transcure Support?
Transcure bills for every nephrology sub-specialty and practice size. Each one follows its own Medicare and commercial payer rules. Here are the areas our renal billing team covers.
Dialysis Billing
Our coders bill in-center and home dialysis by modality and month, matching MCP codes to documented visits and patient age.
Interventional Nephrology Billing
Each dialysis circuit procedure under 36901 to 36909 is checked against NCCI edits, so angioplasty, stent, and thrombectomy combinations get paid correctly.
CKD Management Billing
Transcure codes CKD visits with stage-specific N18 codes validated against documented eGFR, adding G2211 where long-term care relationships support it.
Transplant Nephrology Billing
From pre-transplant evaluations to post-transplant follow-ups, our team applies separate coding logic and links immunosuppressive care to Z94.0 status.
Critical Care Nephrology Billing
We capture inpatient consults, acute kidney injury care, and CRRT sessions billed under 90945 and 90947, so no ICU visit goes unbilled.
Pediatric Nephrology Billing
Pediatric MCP codes change across age bands under 2, 2 to 11, and 12 to 19, and our coders check each band before submission.
Nephrology Billing Services Serving Every State in the United States
Transcure offers specialized nephrology billing services across the United States. Our remote operations and local presence enable us to serve nephrology practices nationwide, including the following states.
Our Expertise in Nephrology CPT Codes and ICD-10 Coding
With years of experience in nephrology billing and coding, we specialize in accurately handling nephrology CPT codes and nephrology ICD-10 codes for renal care. Our nephrology coding expertise spans:
90960 to 90962
- ESRD CPT codes for monthly capitation payment in adult patients
90966
- ESRD CPT code for full-month home dialysis in adult patients
90935 and 90937
- Hemodialysis CPT codes for single and repeated evaluations
90945 and 90947
- Peritoneal dialysis CPT codes for single and repeated evaluations
36901 to 36909
- Dialysis circuit CPT codes for vascular access procedures
N18.1 to N18.6
- ICD-10 codes for CKD stages one through five and ESRD
Z99.2
- ICD-10 code for dependence on renal dialysis
I12.0 and I12.9
- ICD-10 codes for hypertensive chronic kidney disease
E11.22
- ICD-10 code for type 2 diabetes with diabetic CKD
How Transcure's AI Agents Keep Your Nephrology Billing Ready for 2027?
CMS has proposed a CY 2027 ESRD PPS base rate of $299.55, up $17.84 from $281.71. Most of that increase, $15.96, comes from folding phosphate binders into the bundle. CMS also proposed six Low-Volume Payment Adjustment tiers and a training add-on rising from $95.60 to $138.22. One missed update leaves denied claims stacking in your A/R.
Transcure’s AI agents keep your claims current. ELIXA verifies dialysis and transplant coverage in real time, while PRIA handles prior authorizations. CODIN maps every rate, modifier, and CPT change to your claims before submission. CLAIR scrubs each claim against payer rules, and DEXA tracks denials and drafts appeals. Certified coders review every flagged claim, so your practice bills at 2027 rates from day one.
Why Should Practices Outsource Nephrology Medical Billing Services to Transcure?
Nephrology practices partner with Transcure’s medical billing services for renal-specific coding, lower overhead, and clear pricing. Below are the six reasons practices stay with us year after year.
AAPC and AHIMA Certified Nephrology Coders
Over 1,100 certified billers and coders work across our specialty teams. Nephrology claims go to coders trained on ESRD, MCP, and CKD rules.
AI Automation Across the Revenue Cycle
Seven AI agents handle eligibility through A/R follow-up. Certified coders review every flagged claim before it leaves our system.
Transparent Percentage-Based Pricing
Nephrology billing costs around 4% to 5% of monthly collections. You pay only when we collect, with no setup fees or long-term contracts.
Dedicated Account Manager
A named nephrology account manager is available 24/7. Questions about denials, payer changes, or reports go to one consistent contact.
HIPAA, ISO, and CMS Compliance
Our workflows follow HIPAA, ISO standards, ESRD PPS rules, and CMS guidelines. Automated pre-submission audits back every claim.
Multi-Specialty Nephrology Billing
Transcure has expertise in billing multiple nephrology specialties, including transplant nephrology, pediatric nephrology, and hypertension kidney care.
How Does Our Nephrology Billing Onboarding Process Work?
Getting started with our nephrology billing company is simple and straightforward. Here’s how our onboarding process works, from your first call to going fully live.
Step 1.
Practice Assessment & Discovery Call
We review your workflows, denial trends, payer mix, and EHR.
Step 2.
Credentialing & Payer Enrollment Review
Enrollment gaps for ESRD, dialysis, and transplant billing get closed first.
Step 3.
EHR Integration, No Platform Change Required
Our AI agents connect to your current EHR and practice management system.
Step 4.
Custom Nephrology Coding & Compliance Setup
CKD staging rules, ESRD PPS bundling logic, and state payer rules are configured.
Step 5.
Parallel Claims Testing
est claims run alongside your current process to validate accuracy before go-live.
Step 6.
Full Go-Live with a Dedicated Account Team
Your dashboard shows A/R, denials, and collections from day one.
Our Certifications
Transcure’s nephrology billing team holds industry-recognized certifications to make sure that renal claims meet CMS compliance standards and payer-specific coding requirements.
Which Nephrology EHR Systems Does Transcure Support?
Transcure integrates with 40+ EHR platforms used in renal care. Our coders pull documentation directly from your system without changing clinical workflows.
Trusted by Thousands Across the Nation
Our results speak for themselves, as we are consistently rated top-tier nephrology billing company by clients on every major review platform.
What Practices Say About Our Nephrology Medical Billing Services?
Explore the success stories of our partnered practices to see how our outsourced nephrology billing service helps nephrologists improve revenue.
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.
Beth Irwin
Director of Operations
Colorado Kidney Care
Our practice handles a high volume of dialysis and CKD claims every month. Transcure has made that workload much easier for our team. Their coders know nephrology billing, and our denials have dropped since we started working with them. The team is professional and easy to work with.
Dr. Mark Barney
Nephrologist
Nevada Nephrology Consultants
As a nephrologist, I want to spend my time with patients, not chasing claims. Transcure handles our billing from start to finish, including our monthly dialysis visits. I trust their team to get the coding right. I would recommend Transcure to any nephrology practice.
Frequently Asked Questions About Nephrology Billing
Get answers to the most common questions nephrology practices ask about our billing services, ESRD compliance, and CMS reimbursement rules.
What is Nephrology Billing?
Nephrology billing is how your practice gets paid for kidney care services. It covers CKD management, dialysis coding, ESRD monthly payments, transplant evaluations, and vascular access procedures. It runs on Medicare rules because most dialysis patients qualify for Medicare regardless of age.
What CPT Codes are Used For Dialysis Billing?
The most common CPT codes for dialysis billing are 90960 to 90962 for ESRD monthly capitation based on visit count. Hemodialysis uses 90935 and 90937. Peritoneal dialysis uses 90945 and 90947. If a patient gets hospitalized, you bill daily using 90970.
Why Do Nephrology Billing Claims Get Denied So Often?
Most denials come from missing CKD stage codes, wrong MCP visit counts, bad payer sequencing on dual-eligible patients, and missing modifiers. Nephrology has more moving parts than most specialties because of bundled payments and strict Medicare documentation rules.
How Much Does Transcure Charge for Nephrology Medical Billing?
Transcure charges between 3% and 5% of monthly collections for nephrology billing services. Your rate depends on practice size, claim volume, payer mix, and ESRD patient count. No setup fees. No long-term contracts. Your practice pays only when Transcure collects.
What is the New ESRD PPS Base Rate For 2026?
CMS raised it to $281.71 per treatment, up $7.89 from the 2025 rate of $273.82. That reflects a 2.1% market basket update minus a 0.8% productivity adjustment.
Nephrology Billing Knowledge Center
Explore the latest nephrology billing insights to enhance practice performance and profitability.
Nephrology Billing: Definition, Codes, Process, and Guidelines
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Nephrology CPT Codes and Common Modifiers Explained
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