Can it track and bill for home dialysis patient monitoring?

Yes. We support home hemodialysis and peritoneal dialysis monthly capitation billing, training session codes, and remote monitoring claims for home dialysis patients.

Does it support ESRD Quality Incentive Program (QIP) reporting?

Absolutely. Our quality module aggregates Kt/V adequacy, anemia management, and mineral metabolism measure performance and submits directly to CMS QIP registries.

What services are excluded from the ESRD PPS bundle and can be billed separately?

CMS publishes an annually updated excluded drugs and biologicals list. Key excluded items include calcimimetics (cinacalcet/Sensipar billed as J0604), certain ESA agents above specific dose thresholds, and separately billable drugs when therapeutically required. Our excluded services engine is updated with each CMS final rule release and automatically identifies excluded items before each dialysis session claim is submitted.

How does the system handle the professional versus facility fee split for dialysis nephrologists?

Nephrologists bill monthly capitation fees (CPT 90960–90966) based on the number of dialysis sessions supervised per month, while the dialysis facility bills separately for the technical service. Our system generates the physician monthly capitation claim and tracks the session count automatically, preventing the common error of nephrologists over- or under-billing based on inaccurate session counts.

What is the transitional care management billing opportunity for CKD patients before ESRD?

Transitional care management (TCM) codes CPT 99495 and 99496 can be billed for CKD patients discharged from inpatient status, with enhanced contact requirements and a face-to-face visit within 7 or 14 days. Our system flags CKD patients post-hospitalization, tracks the required contact timelines, and alerts providers when the face-to-face visit window is approaching to capture this frequently missed revenue.

How are vascular access procedures for dialysis patients billed?

AV fistula creation, AV graft placement, and fistulogram/angioplasty procedures require specific modifier sequences based on the access type, surgical approach, and relationship to prior procedures. Our vascular access billing module applies correct modifier -50 (bilateral), -59 (distinct procedural service), and facility/professional split rules for each procedure type.

Does the platform support acute kidney injury (AKI) inpatient consultation billing for nephrologists?

Yes. We support inpatient nephrology consultation billing (CPT 99252–99255) for AKI management, tracking the clinical complexity level required for each code tier and confirming that the documentation supports the requested level of service. We also support AKI dialysis support billing during inpatient stays under the hospital facility's separately billable acute dialysis codes.

Nephrology PM & RCM Software

Nephrology Practice Management and RCM Billing, Built to Perform

Master ESRD bundle billing, dialysis facility fee splits, and CKD progression documentation. See why nephrology practices choose Unlimited Systems for practice management and RCM software.

Why Nephrology billing is different

Nephrology practices face uniquely complex billing environments spanning outpatient CKD management, inpatient acute kidney injury consultations, vascular access procedures, and the heavily regulated ESRD Prospective Payment System bundle.

The ESRD PPS bundle consolidates over 50 previously separate services into a single per-treatment rate. Failing to properly document excluded services or correctly split professional and facility fees leads to catastrophic revenue compression that generic systems cannot prevent.

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HOME SPECIALTIESNephrology & Dialysis RCM Software

Trusted Payer & EHR Integration Partners

6,500+

providers nationwide

$70B+

in claims processed annually

4.8/5

average client rating

Designed Around How Your Nephrology Practice ACTUALLY Works

Our connected workflows are built to make you and your work easier to do and increase your revenue.

Visit-ready

Keep authorization and coverage aligned before the appointment is booked.

Claim-ready

Validate nephrology codes, modifiers, and documentation before submission.

Practice-ready

Give teams one view of denials, margin, and A/R priorities.

Specialty RCM intelligence

Nephrology Revenue Cycle Challenges

ESA and iron therapy billing complexity makes dialysis-adjacent RCM uniquely challenging.

15%

Est. denial rate

7/10

Prior-auth burden

Where revenue is at risk

ESA Billing

Aranesp and Epogen are heavily scrutinized by CMS and require hemoglobin monitoring documentation.

How the platform addresses this

Hemoglobin thresholds and dosing policy are checked before administration.
J-code units are validated against the documented dose.
Payer-specific ESA coverage rules are applied automatically.

See it on your own claims

Buy-and-bill drug reference5 agents · codes, channel, prior-auth, and billing notes

Drug	Code	Route	Channel	Cost	PA	Billing notes
Aranesp (darbepoetin)	J0881 / J0882	SQ/IV	Part B	$8K/yr	Yes	Hgb threshold documentation required each visit.
Injectafer (ferric carboxymaltose)	J1439	IV	Part B	$3K/course	Sometimes	Two-dose protocol; single-use vial JW required.
Venofer (iron sucrose)	J1756	IV	Part B	$1K/yr	No	Multi-dose vial; partial dose tracking needed.
Parsabiv (etelcalcetide)	J0606	IV	Part B	$6K/yr	Yes	3x/week dialysis dosing; bundle exclusion critical.
Monoferric (ferric derisomaltose)	J1437	IV	Part B	$2K/course	Sometimes	Newer; single-dose; JW required.

Cabinet integration: Dialysis-adjacent nephrology practices using in-office IV therapy rely on accurate dispensing records. Without ADC integration, ESA dose tracking across visits fails audits, especially for Hgb threshold compliance.

Real Nephrology Practices, Real Results

See how nephrology groups across the country use Unlimited Systems to lift collections, cut denials, and reclaim staff time.

Featured Practice

Nephrology Partners of the Midwest

Columbus, OH14-provider group practice

“Unlimited Systems gave our nephrology billing team the specialty-specific automation we could never get from a generic platform. First-pass claim acceptance climbed fast.”

- Director of Revenue Cycle

23%

Fewer denials

11 days

Faster A/R

Calculate Your RCM Revenue Leakage

Drag the sliders to estimate how much unrealized cash remains locked in your current specialty billing cycles before optimization.

Model your current claim volume

Adjust both inputs to match your practice.

Monthly specialty claims1,500

200 claims15,000 claims

Average claim value$250

$80 value$3,500 value

Estimated annual revenue recovered

$315,000

Calculated using a 7.0% reduction in write-offs from rejection recovery, pre-authorization verification, and drug-waste capture.

Monthly invoiced volume: $375,000
Standard industry loss: $31,875

Unlimited Systems Guarantee: Fully integrated bi-directional EHR triggers maintain first-pass bill submission scores above 98.6% across regional payer rules on day one.

Review my results

See your recovery estimate

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See Your Results Immediately5/55/54.8/5

One platform for every nephrology workflow

Eight connected capabilities, grouped around the way your practice works.

Front office

Keep registration and appointment calendars in sync.

Patient intake Scheduling

Before the visit

Verify coverage and catch charge risk early.

Financial clearance Charge validation

Revenue cycle

Post payments, route denials, and prioritize A/R.

Payment and denials A/R management

Practice intelligence

See margin, performance, and value-based results.

Analytics Value-based care

The Nephrology suite

Every part of the nephrology revenue cycle, in one system

Each module is configured for the codes, modifiers, and payer rules nephrology teams work with, not adapted from generic billing software.

Nephrology Patient Intake SoftwareVerify Medicare ESRD coverage, secondary payers, and dialysis patient enrollment status at intake.Nephrology Scheduling SoftwareManage three-times-weekly dialysis sessions, vascular access check-ins, and CKD clinic slots.Nephrology Financial Clearance SoftwareIdentify billable excluded services outside the ESRD bundle before session completion.Nephrology Charge Validation SoftwareEnforce professional vs. facility fee splits and validate vascular access procedure modifiers.Nephrology Payment Posting SoftwareAuto-post complex bundle payments and reconcile excluded service remittances separately.Nephrology AR Management SoftwareIdentify and bill missed transitional care management codes for pre-dialysis patients.Nephrology Analytics SoftwareMonitor per-session reimbursement rates, bundle exclusion yields, and facility profitability.Nephrology Value-Based Care SoftwareSubmit CMS ESRD Quality Incentive Program (QIP) measures to protect payment adjustments.

The cost of generic billing

You went into nephrology to treat patients, not to chase claims

These are the places nephrology practices most often lose revenue when their billing platform wasn’t built for the work. Unlimited Systems closes each one with rules configured for your specialty.

Review your workflow

Common nephrology revenue leaks

Missed revenue from ESRD bundle exclusions on separately-billable drugs and laboratory services.
High volume of same-day vascular access procedure denials due to missing modifier coordination.
Difficulty tracking professional component billing separate from dialysis facility fees.
Underutilization of CKD transitional care management codes for pre-ESRD patients.

Challenges we solve for nephrology

The work that generic platforms leave to your staff is the work nephrology margin actually turns on.

ESRD Bundle Exclusions

Automated exclusion engine flags all separately-billable services before claim submission.

Vascular Access Billing

Pre-audited vascular access templates automatically apply correct surgical modifiers.

Professional/Facility Split

System generates separate physician claims from facility remittances automatically.

Legacy software vs. Unlimited Systems

See why nephrology practices move off general-purpose billing platforms.

CRITERIA

LEGACY SYSTEM COMPROMISE

UNLIMITED SYSTEMS VALUE

ESRD Bundle Exclusions

✕Excluded services like calcimimetics and ESAs are bundled inside the PPS rate, leaving revenue uncollected.

✓Automated exclusion engine flags all separately-billable services before claim submission.

Vascular Access Billing

✕AV fistula and graft procedure claims are denied for missing modifier sequences.

✓Pre-audited vascular access templates automatically apply correct surgical modifiers.

Professional/Facility Split

✕Nephrologist professional fees get bundled into facility claims, reducing physician collections.

✓System generates separate physician claims from facility remittances automatically.

Still evaluating

Not Ready to Switch Yet? That's Exactly When to Start the Conversation.

You don't have to be actively replacing your current system to have a useful conversation with Unlimited Systems. Many nephrology practices talk with us months before a contract renewal or system evaluation to understand where ESA documentation, iron therapy billing, lab-value support, and dialysis-related complexity may already be showing up.

Get a Demo Benchmark Your Current Workflow

A conversation can help surface where ESA hemoglobin documentation, iron infusion dosing and wastage, TSAT/ferritin lab support, and bundle-versus-fee-for-service decisions may be creating audit and denial exposure.

Less billing work between the visit and payment

Specialty rules and connected data keep your team focused on the exceptions that need judgment.

Verify before the visit

Coverage and authorization stay tied to the order.

Validate specialty charges

Code, unit, and modifier checks happen before filing.

Work the right accounts

Denials and A/R are ranked by value and filing risk.

Care team in scrubs walking through a clinic corridor

35%less manual workflow time

One platform

The rest of the platform your nephrology practice runs on

The same connected system handles the operational work that sits either side of billing.

Patient Intake

Digital intake, eligibility, and demographic capture before the visit.

Explore Patient Intake

Patient Scheduling

Smart calendars and resource scheduling across providers and locations.

Explore Patient Scheduling

Financial Clearance

Automated eligibility checks and prior authorization management.

Explore Financial Clearance

Charge Validation

Pre-claim scrubbing for coding, modifiers, and compliance accuracy.

Explore Charge Validation

Built for nephrology

Follow one nephrology patient from intake to payment

Eight stages, one record. Nothing is rekeyed between systems, so a detail captured at the front desk is still there when the claim goes out, and when the remittance comes back.

Walk the workflow with us

Frequently asked questions

We maintain a continuously updated excluded services list aligned with the CMS ESRD PPS final rule, automatically routing excluded drugs, labs, and supplies outside the bundle for separate billing.

New to revenue cycle terminology? Browse our healthcare RCM & billing glossary.

We Love Hearing From Our Users

Practices like yours, on what changed after moving to Unlimited Financials.

EXPLORE PRODUCTS GET A DEMO

★★★★★4.8/5

★★★★★5/5

“

I'd love to set up a call to talk about SCOA, and the success we've had with Unlimited Financials.

Sam Wheeler

CFO, SCOA

“

The system continues to grow with features as it should, with how healthcare changes. So, if you are looking for a company that is innovative and truly cares, I would recommend Unlimited Financials.

Ernelita Dacumos

Billing Manager, SHOM

“

Unlimited Financials has been the easiest and best practice management system I have used. It is easy to navigate and do what I need to do.

Melissa Shook

Medical Biller, SHOM

“

I would recommend Unlimited Financials to other specialty practices.

Michelle Leandri

CEO, NEPA

“

We transitioned to Unlimited Financials in 2024... the team and platform are absolutely amazing.

Gina

Administrator, FOUR

“

We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.

Renee Bernacchi

Accounts Receivable Coordinator, COAS

“