Subject: Nephrology billing proposal: scope, workflow, and full fees

Hello,

We are comparing billing companies for a U.S. nephrology organization. Please answer in writing.

ABOUT US
- Organization and state(s): [fill in]
- Clinicians and locations: [fill in]
- EHR and practice-management system: [fill in]
- Billing we need: [physician claims / dialysis facility claims / both]
- Where we work: [office / hospital / in-center dialysis / home dialysis / access procedures / transplant care]
- Payer mix and rough monthly collections: [totals only]
- Main problem to fix: [fill in]
- Help we want: [full service / coding only / denials / old claims / other]
- Target start date and notice owed on our current contract: [fill in]

PART 1. SHOW US HOW YOU WOULD HANDLE THESE FIVE MADE-UP CASES
These made-up cases use Original Medicare ESRD rules for patients age 20 or older. For each one, tell us what you would bill, what records you would need, and which Medicare source you rely on.

If we need office-only billing, replace the five dialysis cases below with this question: Walk us through how you would turn a made-up CKD office-visit note into a claim, including the records you need and who answers coding questions.

1. An in-center dialysis patient age 20 or older has 13 treatments and 3 documented qualifying face-to-face practitioner visits in a full month. Which monthly code do you bill, and what do you count?
2. A patient age 20 or older is on home dialysis for the full month. What do you bill, and what must be documented?
3. A home dialysis patient age 20 or older gets a full monthly assessment and one face-to-face outpatient visit, then is in the hospital for part of the month. Do you bill the full month or per day?
4. A home dialysis patient age 20 or older is managed for 14 outpatient days and has at least one documented face-to-face visit, then is in the hospital for the rest of the month. No full monthly assessment was done. What do you bill?
5. A new dialysis patient has employer group health coverage. Which payer do you bill first, how do you track the 30-month coordination period, and what happens when it ends? What if Medicare was already primary because of age or disability?

PART 2. FIVE THINGS WE NEED IN WRITING

6. Claims: Do you bill our physician claims, dialysis facility claims, or both? Is facility billing a separate fee?
7. Charge capture: How do hospital and dialysis-unit charges reach you, and how do you show each month that none are missing?
8. Systems: Will you work in our current system, or must we move to yours? If we leave, what data do we get, in what format, and at what cost?
9. Fees: What is your percentage or other fee, and exactly which receipts does it apply to? List any monthly minimum and every other charge: software, interfaces, clearinghouse, coding, statements, setup, credentialing, old claims, and exit costs. Mark anything you have not quoted.
10. Contract: What are the term, renewal, cancellation notice, and exit fees? Who works old claims when we start and after we leave?

ALSO PLEASE SEND
- A sample monthly reconciliation report with made-up data.
- The definition, time period, and client group behind any performance number or guarantee you advertise.
- Your business associate agreement and a list of subcontractors who would touch our data.
- A nephrology client we can contact, with their permission.

Please tell us which items you can show today and which still need scoping.
Please do not ask for patient records by regular email or a public web form.

Thank you,
[Name and role]
[Practice and contact details]