The same patient moves from CKD management to dialysis to transplant, and the billing model changes at every step.
eGFR trend and referral reason captured at intake.
Stage coded to the current eGFR and albuminuria, not a prior visit.
Diabetes, hypertension and cardiovascular risk captured for HCC.
Dialysis modality education and access planning documented in time.
Fistula or graft placement coded to the approach actually performed.
First MCP month reconciled against the visit count and modality.
Complexity tier and bundled labs checked against MCP rules every cycle.
What actually lands in the account after staging-aware review.
Five governance checks confirm every MCP requirement is met before the monthly claim is built.
Monthly face-to-face visit count confirmed against the 1, 2 or 3-visit tier before billing.
Age tier and comorbidity documentation checked against the complexity level billed.
In-center, home HD and PD coded to the modality actually delivered that month.
ESA, iron and lab draws checked against what the bundle covers versus bills separately.
Every monthly capitation claim logged against the visits and documentation that support it.
Monthly capitation billing used to be rebuilt by hand every cycle. Now it just reconciles.
CKD staging finally drives the code automatically instead of lagging the chart by a visit.
The first partner that tracked vascular access status alongside the billing, not separately.
