The revenue for the nephrology medical billing services is associated with on-time billing, account reimbursement, and timely follow-up. When it comes to the business aspect of medical services, dealing with a highly qualified medical billing services company is the most crucial decision that medical service providers have to make.
This would be true, especially for Nephrologists who have to keep traveling from one district to another to treat their patients for dialysis, for chronic kidney diseases, and to cater to their financial needs by managing the revenue cycle on the top. Nephrology medical billing can be challenging and can take a toll if denial rates get higher than the accepted ones.
Nephrology medical billing is complex because providers have to file separate claims for every individual case of dialysis treatment. But it is the only way to efficiently manage account receivable, accurate billing, and clean claims. By complying with nephrology medical billing guidelines and the use of accurate CPT codes, providers can save time in doing much-needed tasks.
Ways how Nephrology Medical Billing can help you
Here are some ways of billing (that are nephrology code specific) that can help you improve your efficacy in managing your practice.
Real-time eligibility
Verification and confirming a patient’s coverage can take a lot of time at a practice front office. In cases of emergencies when it becomes impossible sometimes to verify patient coverage, they create reimbursement issues later.
Through nephrology-specific billing, the process offers a provider real-time verification opportunity. With this feature, staff at a provider’s office can verify copays, insurance, co-insurance coverage, benefit status, and the list of services covered in just a click. In a few seconds, the staff has all the information on whether the patient is covered for the services or not.
Electronic Claim Submission
Everything that is done manually is time-consuming and automatically becomes error-prone. At nephrology, providers need to file individual claims and these should be coded accurately. Nephrology standard billing software allows providers to submit multiple claims based on similar categories such as patients covered by insurance and claims per visit levels.
For instance, if a provider sees 4 level 10 patients having a United Healthcare insurance plan, a provider can submit a claim to the payer for all of these 10 patients with a click. This eventually reduces claim denials and providers get more time for tasks in hand.
How software supports nephrology medical billing
Several software features offer great help to providers in easing their billing process. Some of them include;
Comprehensive dialysis reporting – This feature tracks how many patients have reached the threshold of visiting four times to the practice and now become eligible to receive efficient medical care.
Advanced Dialysis tracking – this feature allows providers to trace a patient list where their visit is due and act as a reminder to call patients to complete their required monthly visits for dialysis.
Patient portal – Through the online patient portal, the feature grants access to patients to see test results, know about their next visits, knowledge about treatment and medical history. They can also schedule their appointments, complete required forms digitally, and even make payments using credit/debit cards.
ICD-10 Nephrology coding for individual billing
While nephrology billing software is a standard way of filing claims, in medical practice, to improve the specificity of the services provided, ICD-10 codes are mandated to implement.
In the past few years, regulations for implementing ICD-10 codes have updated drastically and this makes nephrology coding more complex. This is why, today, claims with less specified diagnosis ICD-10 codes result in claim denials and even penalties. Besides, this approach is regulated not only by Medicare but by third-party/private payers too.
To eliminate the chances of claim denials, ensure that your nephrology billing practice is implementing designated specified diagnosis codes. Your nephrology documentation should be the following;
- Laterality
- The onset of care
- Aetiology and manifestation
- Site specificity (anatomically)
- Non-specific/unspecified
- The severity of the disease
- Combination codes
- And codes for conditions that can easily complicate treatment
Codes for defining chronic diabetes and kidney diseases
Documenting your nephrology patients with diabetes, it is necessary to document complications, manifestations, and current treatment other than the type of diabetes. If hypoglycemia or hyperglycemia is associated with patient diabetes, it is also essential to document it. If a diabetic patient has complications and manifestations, you would need to provide some additional information in your claims. Such as;
- Hyperglycemia
- Site of ulcer
- Gangrene
- chronic kidney disease
- Severe retinopathy
Important Diabetes Codes
Type I Diabetes
- E10.21 – Type I diabetes along with diabetic nephropathy E10
- E10.22 – Type I diabetes along with diabetic chronic kidney disease
Additional code should be used to identify the stage of the patient’s chronic kidney disease
- E10.29 – Type I diabetes with any other diabetic kidney complications like renal tubular degeneration
Type II Diabetes
- E11.21 – Type II diabetes along with diabetic nephropathy
- E11.22 – Type II diabetes along with diabetic chronic kidney disease
Use an additional code to identify the stage of the patient’s CKD
- E11.29 – Type II diabetes along with any other diabetic kidney complications like renal tubular degeneration
- For insulin use, use additional code Z79.4
Essential codes for Documenting Chronic and Hypertensive kidney disease
Several codes are there that are used to diagnose hypertensive kidney disease depending on the condition of a patient and the level of the diagnosis. Codes used for treating hypertensive conditions include;
- I10 – Essential or primary hypertension
- I12 – Hypertensive chronic kidney disease
This code requires the fourth digit as well
- I12.0 – Hypertensive chronic kidney disease along with stage 5 chronic kidney disease or end-stage renal disease
You’ll need to use an additional code to identify the specific stage of chronic kidney disease
- I12.9 – Hypertensive chronic kidney disease, stages one through four chronic kidney disease, or chronic kidney disease that’s unspecified
Once again, you’ll need to use another code to identify the patient’s stage of chronic kidney disease
- I13 – Hypertensive heart and chronic kidney disease
This code also requires you to use the fourth digit
- I13.0 – Hypertensive heart and chronic kidney disease along with heart failure and stage one thru four chronic kidney disease, or unspecified CKD
Use an additional code to indicate the stage of CKD
Use an additional code to note the specific kind of heart failure
- I13.10 – Hypertensive heart and chronic kidney disease without any heart failure along with stage one through four CKD
The stage of CKD must be noted with an additional code
- I13.11 – Hypertensive heart and chronic kidney disease without any heart failure and with end-stage renal disease or stage 5 CKD Additional code for the stage of CKD must be used.
How would you document complications you pose while providing care?
Oftentimes, complications arise because of the care for a patient’s disease or diseases and when this happens, they should be documented. All the complications that the provider comes across during the care or procedure must be documented depending on the level of care and condition.
The documentation in nephrology medical billing cannot be assumed. And this is why the providers need to document every complication that they care for during the treatment if they cannot be coded.
Following these practices and accurate coding can simply ease the process of nephrology-specific billing and improve revenue cycle management.