Medical Billing, Medical Claims

# Why is it Necessary to follow Nephrology Billing and Coding Guidelines?

- August 22, 2024
- Posted by Kristen Edwards

25 Nov

Ever since the ICD-10 codes have made their presence in the healthcare industry, it has become a compulsion to comply with the requirements. With their implications, complying with the nephrology billing and coding guidelines has become more specific and intricate when it comes to following them.

In addition to ICD-10 nephrology billing and coding guidelines, several other requirements are there from the insurance providers for claiming nephrology medical services. To get compensated timely, accurate billing is mandatory and for this, it is necessary to adhere to all the prerequisites of ICD-10, E&M, and CPT coding.

## Ways to Follow Nephrology Billing and Coding Guidelines

Regardless of your specialty, there can be circumstances where you have to travel from place to place for providing healthcare services. This happens mostly with nephrologists who mostly have to provide dialysis and other treatment to kidney patients with severe conditions. Whenever they have to travel to see an outpatient, they have to keep the billing documentation on top of every treatment.

Medical codes obligate physicians to record every encounter with the patients. Even if they visit for the first time, get admitted, or visit another doctor for the continuation of the disease, they have to record the diagnosis, treatment plan, disease, and the future expected treatment with the help of an extensive coding list.

Similarly, when nephrologists visit a patient for treatment, they need to make sure that they record every single encounter with the patient which makes it tedious when it comes to billing and submitting claims for all the dialysis or treatment they provide to patients on a regular basis.

Not only this, nephrologists also have to follow a specific type of claim procedure for receivable accounts. To aid nephrologists in improving their claiming process, the following features can be followed;

### – Verifying eligibility

While claiming the services, you need to have complete information about the insurance company, plans, and coverage. and the patient credentials. To get all the information, the front desk office of a physician’s healthcare facility has to put in a lot of effort to verify and get accurate information which can eventually create complications at the time of filing claims if they are properly gathered.

No matter if a patient agrees to pay out-of-pocket having no insurance plan, they still need to collect information and provide payment options to patients for timely reimbursements.

Nephrology billing provides real-time eligibility checks for on boarded patients. With this billing feature, verify the insurance plan, co-pays, coverages, co-insurance plans, and past availed healthcare services within a few clicks. Along with this, the feature enables the front staff to know whether the patient is entitled to such services from the insurance provider or not.

### – Electronic Claim Submission

As with any other medical practice, nephrologists also have to submit claims for every individual patient separately, which is certainly time taking. When it comes to claiming services for dialysis, they use specific billing software. This dialysis billing software enables nephrologists to bill for multiple dialysis claims at a time. The software also allows them to file claims via the number of visits, treatment provided, and type of insurance coverage.

For example, if a provider visits 4 patients with level 20 nephrology symptoms and they are covered under XYZ insurance company, nephrologists can file claims for all 4 patients under XYZ insurance in just one click for the service reimbursement.

This single-click claiming option from nephrology medical billing software not only reduces the time consumed in separate billing but eliminates the chances of errors and mistakes in billing and claim filling that result in claim denials and rejections. This usually happens when a nephrologist sees several numbers of chronic kidney patients and the increasing number of patients makes it challenging to cater for the previously provided services to bill accurately.

### – Identify RCM gaps

Nephrologists not only use the specific features of the medical billing and claiming software for reducing the time for billing and submitting claims or just for real-time eligibility verification but there are also many other features that they look up to.

It becomes much easier to track the time taken between the provision of the services and the submission of the claim. This identification will help in observing the gap between claim submission and reimbursed claims.

With this feature, providers will have an idea of minimizing the gap between the insurance payers’ reimbursed amounts by finding mid-month and end-month billing patterns. Also, it gives you the opportunity to evaluate the claims that you have missed at the same time.

In addition, these features support healthcare physicians who want to make the most of software that helps them the bill and claim for the best reimbursement practice.

## Nephrology Billing Software and Nephrology Coding

Nephrology medical and billing software provide the nephrology-specific features that provide;

- Custom Templates – Nephrology software provides the feature of customized templates to improve the nephrology workflow no matter if nephrologists are working, examining, consulting, or treating chronic kidney diseases. OR conducting any other procedures related to nephrology.
- Advanced dialysis tracking – This will enable the nephrologists to list down and track the visit and treatment of patients. They can remind you to file the claims for provided services and the payment receivable.
- Patient portal – like any other billing service, the nephrology billing patient portal also provides patients with the ability to check their medical history, and their treatments, schedule appointments, track records and test results along with receiving HIPAA-compliant messages and surveys.
- Comprehensive dialysis reporting – Track the number of patient visits and list down the patient who has completed 4 visits and needs follow-up for the provision of effective care.
- A mobile app – As everyone has the feasibility to remain connected via their cell phones. Nephrology billing software application allows both patients and providers to track required information.

### Required Citations for Nephrology Billing and Coding

In any situation of claiming and billing for nephrology services, it is mandatory for providers to use specified codes with HIPAA compliance, where a single lack of the required documents can lead to rejection and penalties. These non-compliance conditions are not just limited to Medicare but every insurance payer federally licensed or working privately.

As a nephrologist, make sure that your practice follows accurate coding for billing so your reimbursement would be done timely. For this, make sure that your documentation is complete, updated, and that you have provided every document that is required. Here’s a list of documents that you need to have for nephrology medical billing for your practice and for accurate billing;

- The onset care documents
- Laterality
- Site specificity
- The severity of the disease
- Combination codes (non-specified/specified)
- Manifestation and etiology
- The severity of the disease
- Any specified condition that can worsen

Along with these documents, you need to consider a few things for nephrology coding medical-specific billing;

- When you see a patient for any kidney disease, do add all the relevant information using codes but make sure not to overwhelm use codes for an unspecified visit.
- Use additional coding and modifiers to mention additional diseases or symptoms of a patient. If you think one or two codes are not defining the disease completely, then use more codes to explain your diagnosis.

Keep coming back for more information on coding and billing for various practices and medical fields.

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