Dialysis revenue lives in two places at once: the facility's ESRD bundled payment and the nephrologist's Monthly Capitation Payment. Knowing exactly what sits inside the bundle, counting MCP visits correctly, and capturing what is legitimately billable outside it is where six figures a year are won or lost. Healthcare Logic specializes in nephrology and dialysis revenue cycle management, so every treatment, every visit, and every separately payable service is captured under the current ESRD rules.
Nephrology is one of the few specialties where a single patient generates a bundled facility claim and a capitated physician claim every month, with a constantly moving line between what is included and what is separately payable. Generic billing teams that handle nephrology between other specialties routinely miscount MCP visits, bill inside the bundle, and miss legitimate separate revenue.
Medicare's ESRD Prospective Payment System bundles routine dialysis, most labs, ESAs, iron, and oral-only drugs into a single per-treatment rate that reached $281.71 for 2026. Practices that bill separately for services already inside the bundle generate automatic denials, while practices that miss services legitimately billable outside it -- acute inpatient dialysis, separate E/M, certain high-cost drugs -- leave clean revenue uncollected. The line moves with each rule cycle, and missing it costs both ways.
The Monthly Capitation Payment pays the nephrologist one amount per patient per month, and the tier depends entirely on documented face-to-face visits: 90960 for four or more, 90961 and 90962 for fewer. A visit performed but not documented, or documented but not reconciled to the claim, silently downcodes the MCP tier. Across 60 to 100 ESRD patients, undetected visit miscounts are one of the largest recurring losses in nephrology.
When a dialysis patient presents with a new problem requiring distinct medical decision-making, that evaluation and management service can be separately billable with the right modifier and documentation. Without a clear, independent note supporting separate MDM, the visit is either denied as part of the MCP or never billed at all. Transitional care management after a hospital discharge is missed for the same reason: the documentation never reaches the claim.
Original Medicare requires bundling, but Medicare Advantage, commercial, and other payers do not bundle the same way, and applying one logic across all of them produces denials. Layer in value-based kidney care contracting, dual-eligibility coordination, and the 2026 changes to capitation and benchmarks, and the revenue cycle becomes a multi-payer, multi-model operation that a generalist back office cannot run accurately.
Healthcare Logic provides a free nephrology revenue audit -- identifying bundle errors, MCP visit miscounts, unbilled separate E/M and transitional care, and payer-mix denials before they compound.
Healthcare Logic delivers the full revenue cycle stack adapted to ESRD bundled payment, Monthly Capitation Payment coding, AKI dialysis claims, and the multi-payer, value-based reality of modern kidney care.
Accurate institutional billing under the ESRD Prospective Payment System, with the bundled per-treatment rate applied correctly, patient-level adjustments captured, and a precise line drawn between bundled services and what stays separately payable.
MCP physician billing with documented visit counts reconciled every month, so the correct tier among 90960, 90961, and 90962 is billed, including the age-specific and home dialysis capitation codes -- never silently downcoded by an uncounted visit.
Renal dialysis services for patients with acute kidney injury billed under the correct payment rules and outside the chronic ESRD bundle, with documentation that supports the acute designation and protects the claim from denial.
We capture separately identifiable evaluation and management visits and post-discharge transitional care management with the independent documentation and modifiers that make them payable alongside the MCP, instead of leaving them denied or unbilled.
Billing and coding data structured to support Comprehensive Kidney Care Contracting and other value-based arrangements -- accurate diagnosis capture, visit documentation, and dual-eligibility handling that protect benchmarks and shared savings under the 2026 model changes.
Front-end eligibility and payer-specific bundling logic for Original Medicare, Medicare Advantage, and commercial plans, plus aggressive appeals on ESRD and MCP denials -- the overturn discipline that recovers revenue generalist billing writes off.
Healthcare Logic's nephrology workflow covers every step from eligibility verification through value-based reconciliation -- keeping the facility bundle, the physician MCP, and every separately billable service accurate and fully captured.
Most billing teams handle nephrology as a side task between other specialties, and it shows in the denials. ESRD bundling, MCP visit tiers, AKI rules, and value-based kidney care are a full discipline, not a code set. Healthcare Logic's team lives inside the ESRD rules, connecting facility and physician revenue so nothing falls through the line between the bundle and the capitation.
We hold the exact line between bundled and separately billable services, including the 2025 oral-only drug inclusion, so you never bill inside the bundle or miss legitimate revenue outside it.
We reconcile documented visit counts to the claim each month so the correct capitation tier is billed and no visit silently downcodes your MCP.
Separately identifiable visits and transitional care management billed with the independent documentation that makes them payable alongside the MCP.
Correct bundling per payer and data built for value-based kidney care, so Medicare Advantage, commercial, and CKCC arrangements each pay accurately.
Dialysis billing splits into two distinct claims. The dialysis facility bills Medicare under the ESRD Prospective Payment System, a single bundled per-treatment rate that includes routine dialysis, most labs, ESAs, iron, and certain drugs. The treating nephrologist bills separately on a professional claim using Monthly Capitation Payment codes. Knowing exactly what is inside the bundle versus what stays separately billable is the single largest driver of nephrology revenue, and getting it wrong produces systematic denials in both directions.
The Monthly Capitation Payment, or MCP, pays the nephrologist a single monthly amount per dialysis patient rather than a fee per visit, and the amount depends on the number of documented face-to-face physician visits in the calendar month. CPT 90960 applies to patients age 20 and older with four or more visits, while 90961 and 90962 apply to fewer visits. Miscounting visits is one of the most common and most expensive nephrology billing errors, and we reconcile visit counts to documentation every month so the correct MCP tier is billed.
The ESRD PPS bundle includes routine dialysis treatment, most laboratory tests, erythropoiesis-stimulating agents, iron, and, since January 1, 2025, oral-only renal dialysis drugs. Acute inpatient dialysis, separately identifiable evaluation and management visits, some vaccines, and certain high-cost drugs under TDAPA or TPNIES status remain separately billable. Practices lose revenue both by billing for items already inside the bundle and by failing to bill for services that legitimately fall outside it, and we manage that line precisely.
Yes. We bill renal dialysis services furnished to patients with acute kidney injury under the applicable ESRD payment rules, and we manage the differences in Medicare Advantage and commercial billing, where claims do not have to be bundled the same way Original Medicare requires. Misapplying bundling logic across these payers is a frequent source of dialysis denials, and we configure each payer correctly rather than treating them all the same.
Yes. As nephrology practices participate in value-based kidney care arrangements such as the Comprehensive Kidney Care Contracting tracks extended through 2027, accurate diagnosis capture, visit documentation, and dual-eligibility handling directly affect benchmarks and shared savings. We structure billing and coding data to support these models alongside fee-for-service collections, so participation strengthens revenue rather than complicating it.
Talk to a Healthcare Logic nephrology specialist and get a free analysis of your ESRD bundle accuracy, MCP visit capture, separate billable revenue, and denial recovery.
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