"Nephrology is one of the toughest specialties to bill for. A single ESRD patient can generate a stack of claims in just one month. In Episode 7 of the MediBillMD Podcast, Sarah and RCM specialist Mike break down nephrology revenue cycle management for 2026: monthly capitation payments, dialysis and vascular access billing, prior authorization, documentation, and the best practices that stop revenue leaks.
📖 Read the full guide: https://medibillmd.com/blog/nephrology-revenue-cycle-management-guidelines/
In this episode, you'll learn:
✅ Why nephrology billing is so complex
✅ How monthly capitation payments (MCP) work for ESRD patients
✅ Why MCP codes are tiered by face-to-face visits
✅ When a separate E/M visit can't be billed (and the bundling trap)
✅ Dialysis session and vascular access billing basics
✅ Prior authorization and documentation tips that prevent denials
✅ Common nephrology RCM challenges and how to fix them
⏱️ Chapters
0:00 Intro
0:18 Why nephrology billing is so complex
0:57 Monthly capitation payments (MCP) explained
2:02 Dialysis sessions and vascular access billing
2:41 Prior authorization and documentation
3:10 Common nephrology RCM challenges
3:40 Nephrology RCM best practices
4:15 How MediBillMD can help
📋 Nephrology codes mentioned:
- CPT 90960–90962 – Monthly ESRD services, adult in-center dialysis (tiered by face-to-face visits)
- CPT 90963–90966 – Home dialysis oversight
- CPT 90935, 90937, 90945, 90947 – Hemodialysis and peritoneal dialysis sessions
- CPT 36901–36909 – Dialysis circuit / vascular access procedures
Note: payer rules change often. Always verify current guidance with CMS and each payer.
📊 Key metrics to track: clean claim rate, MCP compliance rate, and denial rate by code category.
Need help with nephrology billing? MediBillMD's nephrology billing team knows MCP rules, dialysis code hierarchies, and ESRD bundling inside out, and keeps up with Medicare, Medicaid, and commercial payer changes.
📞 Call: (877) 353-9542
🌐 Website: https://medibillmd.com
✉️ Email: info@medibillmd.com
🔗 Nephrology billing services: https://medibillmd.com/specialties/nephrology-billing-services
📅 Book a free consultation: https://medibillmd.com/appointment
#NephrologyBilling #NephrologyRCM #DialysisBilling #ESRD #MediBillMD"
