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5 Unique Challenges Nephrology Practices Face Related to Billing

March 25, 2019

Nephrology-Billing-ChallengesFrom electronic health records to dealing with patient no-shows to trying to manage time effectively, physicians face challenges daily. However nephrology practices deal with unique challenges that can make it more difficult to keep your practice growing and performing well. Here’s a closer look at some of the big issues that nephrology practices often face, as some helpful tips on how physicians and practice managers can deal with them effectively. 

Challenge #1 Claims Spend Too Many Days in Accounts Receivable

One challenge for nephrology practices that can have a significant impact on your profit margin is the days a claim spends in accounts receivable. The problem the longer a claim stays in limbo, the greater the risk that it won’t be paid. If you don’t have the right processes in place to collect on these claims, your practice will be leaving money on the table. 

Davita notes that it’s critical to delegate competent individuals to accounts receivable positions with nephrology-specific skills. This way you ensure that claims are not spending too much time in accounts receivable so keep the revenue cycle moving efficiently for your practice.  

Challenge #2 – Failure to Document a History of Present Illness 

Lack of documentation– it’s one of the big billing and coding challenges. It’s especially an issue within nephrology when it comes to providing enough documentation on the history of a present illness. More documentation is required than ever before, and it’s essential to make sure that your practice’s clinicians are aware of the documentation requirements for history of present illness. They include: 

  • Location – Where’s the location of the problem? Example: abdomen, kidneys, etc. 
  • Duration – How long has the patient had their chief complaint? Example: chronic renal insufficiency since 2019, has had Chronic kidney disease (CKD) for 5 years
  • Timing – How often does the problem occur? Time of day? Example: HA is intermittent, frequency gets worse in the evening 
  • Severity – What’s the degree or intensity of the patient’s chief complaint? Example: Patient’s Glomerular Filtration Rate (GFR) decreased from __ to __

Other things that may need to be documented include: 

  • Quality 
  • Any modifying factors 
  • Any associated symptoms and signs
  • Context of the chief complaint 

Challenge #3 – Differentiating Your Practice from Your Competitors 

For most nephrology practices, their prices are determined by the Medicare Fee Schedule, which means that you can’t differentiate your practice by offering better prices. And most clinicians provide a high level of care. So, what can nephrology practices do to differentiate themselves from competitors? It really all boils down to the service that you provide to your patients on a daily basis. Focusing on the patient experience isn’t just key to making your practice stand out, private insurers, Medicaid, and Medicare are all putting a bigger emphasis on patient satisfaction scores as well. If those scores drop, it can result in financial consequences, too. 

Challenge #4 – Patient Compliance 

Patient compliance is a huge issue within the nephrology field, particularly among patients who require dialysis. It’s very common for prescriptions to go unfilled. Patients may try to stretch their prescriptions to keep down their out-of-pocket costs. Follow-up care may be neglected, and adherence to treatment recommendations may be as low as 50% in some patient groups. In fact, studies show that at least 50% of hemodialysis patients are noncompliant with a part of their treatment regimen. Not only does this put patients at risk of serious complications, but it also affects healthcare providers, too. 

Challenge #5 – High Claims Denial Rates 

Another challenge nephrology practices often face is high claims denial rates. Your practice denial rate is the percentage of claims that are denied by payers. According to Med Converge, almost 26 percent of all claims made to CMS are denied. Of those denials, 40% of them never get resubmitted. Failing to control and manage your claims denials results in lost revenue and a negative impact on your practice’s bottom line. 

The most significant step your practice should be taking is to prevent claims denials. Reworking claims is very costly, so the most cost-effective thing you can do is make sure you check for missing information and coding errors before you submit claims the first time. A quality practice management system or outsourcing your billing and coding can both help you address this challenge. 

If you’re thinking about outsourcing your billing and coding, we can help. We’re experts in nephrology billing and coding and can work with you to lower denial rates and the number of days claims spend in accounts receivable. Let us help you with some of the big challenges facing nephrology practices today. Contact M-Scribe for more information.


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