Nephrology is an extremely complex specialty when it comes to correct coding and billing for services. Renal patients, who may be in various stages of renal disease or failure, often require a multitude of interventional services and treatments, such as ultrasound, dialysis and kidney transplants. Accurate, detailed documentation, coding and billing are especially critical to submitting a clean renal claim that will be paid without worry about a denial or worse – a RAC audit.
Because of ever-present changes in the field you need a medical billing and coding service that is familiar with the government and insurance regulations affecting renal claims, such as requiring the presence of the attending doctor during a dialysis session. Issues including monthly billing for peritoneal and hemodialysis as well as the correct use of modifiers in appending procedures are too complex and critical to the billing process to be turned over to inexperienced, untrained companies.
Other considerations include kidney stone management, a second opinion where cancer may be present, and there may be surgical-assisted fees, bundling issues and bilateral and multiple procedures where applicable. If your practice involves a significant number of managed care patients, you need to be aware of the need for proper authorization of these patients by their primary care physicians, as this is directly tied to your claim; lacking the necessary certification could result in your claim being delayed or denied altogether.
We believe that your medical practice should have a team of coding and billing professionals who are experienced in the area of nephrology practices and the many nuances of coding and billing. While the ICD-10 codes should remove much of the guesswork from correctly coding diagnoses and their treatments and procedures, they are only effective if the person using them are trained and have had sufficient experience.
Related Article: Current Issues with ESRD and Dialysis Billing
We are nephrology billing experts, also providing coding and auditing as a separate service to many practices. Our coders assigned to every account are certified as well as experience in nephrology. Your claims are given the attention to detail that they deserve, resulting in faster and more complete reimbursement to your practice and its bottom line.
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