Dialysis patients are billed through a monthly capitation payment that depends on visit count, age, and setting. A hospital stay or transplant can turn that month into per-day billing. CKD clinic work and kidney disease education follow their own rules.
Book a demoMost nephrology billing runs on monthly dialysis management, with clinic and education work around it.
For patients who dialyze in a facility, Medicare pays the monthly capitation payment once per month, with separate codes for one visit, two to three visits, and four or more. Patient age also changes the code, so visit dates have to be captured as they happen.
Home dialysis patients carry one monthly rate by age, and the physician must furnish at least one face-to-face visit that month. When a patient is hospitalized, receives a transplant, or changes physicians mid-month, CMS directs per-day billing in some of those cases.
Earlier-stage CKD visits follow the usual office claim path. Medicare Part B also covers up to six sessions of kidney disease education for patients with stage 4 CKD who are referred by their kidney physician.
The nephrologist and the dialysis unit bill for different things, and Medicare edits enforce the line.
Your nephrologists document each dialysis visit, the monthly assessment, and clinic encounters, and approve codes before submission.
If the fit is confirmed, Taiga would draft monthly and clinic codes from those notes, check eligibility, submit and scrub claims, and work denials and appeals.
ESRD-related labs, drugs, and supplies are paid to the dialysis facility under consolidated billing, and other providers who bill them get denied. Agree which items the practice bills and which go through the facility.
Bring one de-identified month of dialysis rounding notes and a few clinic claims. Keep patient details out of the booking form.
List each dialysis facility, your split of home versus in-center patients, and how visit counts are tracked today.
Explain how hospitalizations, transplants, transient patients, and physician changes are caught so the right monthly or per-day code is chosen.
Describe CKD clinic volume, kidney disease education sessions, and any transplant follow-up the practice bills.
Worth a conversation if your group bills its own professional claims and spends too much time reconciling visit counts and partial months. Taiga runs alongside the EHR you already chart in.
This page is about the nephrologist's professional claims. Dialysis treatments paid under the ESRD prospective payment system are billed by the facility and are outside this conversation.
Nephrology is not on Taiga's public specialty list. A short call about your dialysis and clinic mix will answer whether it fits.
For in-center patients, Medicare's monthly capitation codes vary by the number of face-to-face visits in the month (one, two to three, or four or more) and by patient age. Home dialysis uses one monthly rate by age.
Depending on the visits furnished and the dates, CMS may direct billing with a per-day code instead of the full monthly code. The visit history decides which applies.
Medicare Part B covers up to six one-hour sessions for patients with stage 4 CKD referred by the physician managing their kidney condition. Each session needs documentation that supports the claim.
Share one de-identified month of rounding and clinic work. Taiga will walk through how it would bill it and tell you straight whether the fit is there.
System guides show possible billing handoffs, not proven specialty compatibility.