NEPHROLOGY
An EMR Built for the Slope, Not the Snapshot
Your stage-4 diabetic walks in. The eGFR slope is in front of you before you sit down, the potassium trend is one glance away, the SGLT2i and the ACEi are checked against this morning’s creatinine, and the access-planning conversation starts a year before it has to. That is what your day looks like on GlaceEMR and GlaceRCM, billed at a percentage of collections with no base fees, backed by a billing team that hits 95%+ first-pass claim adjudication and 99%+ collection rate of payer-allowed amounts*.
*Of payer-allowed amounts.
WHAT WE HEAR FROM NEPHROLOGISTS
The Problems Nephrology Practices Tell Us About
Nephrology is the management of trajectory. The slope of the eGFR, the curve of the potassium, the year-over-year drift of the PTH, all of that runs your decision-making, and almost none of it shows up in a horizontal EMR built for somebody else’s specialty. Below is what we hear from nephrology practices in the first thirty minutes of every discovery call.
You manage a curve, but the chart shows you a table. CKD is staged and restaged on the slope of eGFR, and the question of whether this patient is heading toward access planning is a question about the line, not about the last value. A flat lab table tells you almost nothing. Legacy EMR platforms hand you the column and expect you to graph it in your head, visit after visit, patient after patient. The conversation about transplant referral starts late because the trajectory is buried inside a results tab that nobody graphs until the eGFR is already in the 20s.
Dialysis billing has its own grammar, and a general billing team learns it slowly. The 90951 through 90970 series for monthly capitation is stratified by patient age, by modality, and by the number of face-to-face visits per month, and every claim depends on the visit count being right. A horizontal EMR’s billing rules do not know that the comprehensive visit has to happen on a specific cadence, and an unfamiliar biller writes off the difference between a four-visit MCP and a one-visit MCP because nobody flagged the gap on the way out. The revenue loss compounds across an in-center census of forty or fifty patients a month.
ESRD paperwork eats hours. CMS-2728 at initiation, CMS-2746 at death, recertification forms for the dialysis facility, the constant drip of inpatient discharges from the hospital nephrology service, the home-dialysis training notes from the contracted unit. When the forms are not in the EMR, somebody at your office is faxing paper and tracking it on a whiteboard, and the audit that arrives two years later is stressful because the documentation never sat in one place. The work was done; the chart could not prove it.
Access and transplant live in spreadsheets. Vascular access type, placement date, maturation status, surveillance interval, intervention history, last fistulagram. Transplant immunosuppression troughs, DSA panels, BK virus surveillance, rejection workups. On most platforms, those data live in spreadsheets the practice manager keeps in OneDrive or on paper logs the nurse fills out by hand. The chart never tells the whole story, and a covering colleague who picks up a patient at midnight has to call somebody to find out what the access actually is.
Renal dosing depends on a number that keeps moving. Every prescription you write has to be checked against the current eGFR, and the current eGFR changed last Tuesday at the dialysis unit and again this morning in your office. A horizontal EMR’s drug-interaction engine warns you about CYP450 cocktails and stays quiet about the gabapentin dose that just became toxic when the creatinine drifted up half a point. The pharmacist catches some of these, the dialysis nurse catches some, and the rest become hospital admissions for confusion or hyperkalemia.
Your panel is multimorbid and high-risk, and the coding never reflects it. The average nephrology patient carries CKD, diabetes, heart failure, hypertension, anemia, mineral bone disease, and a handful of secondary diagnoses on top. Stage-specific ICD-10 capture is the difference between an N18.9 unspecified claim and an N18.4 stage-4 claim, and that single digit determines both the reimbursement and the HCC contribution. On most platforms, your problem list still says CKD unspecified five years into your relationship with a patient whose creatinine has been north of 3.0 the entire time.
The work happens across three buildings. Your office in the morning, the dialysis unit by lunch, the hospital floor in the afternoon, sometimes a home-dialysis training visit by phone in between. The chart that follows you into the dialysis unit is the same chart that has to follow you into the hospital, and on most platforms it does not. You log in to a different system at every site, document twice, and pay a different vendor for each one. Your team spends as much time reconciling the three records as taking care of the patient.
GLACEEMR FOR NEPHROLOGY
An EHR Designed Around CKD Trajectory and Dialysis
GlaceEMR is ONC-certified and has been deployed in private nephrology practices since 1999, with 30+ years of company history behind it. Every feature below is in the platform today, not a roadmap promise. The nephrology configuration is wired in before training starts, so the chart your team opens on day one already knows the slope, the modalities, and the workflows your day actually runs on.
eGFR slope and automatic CKD staging
eGFR and creatinine trended longitudinally with automatic CKD staging using the CKD-EPI 2021 equation, with the slope visible at every visit and progression flags surfaced in the encounter window. The proteinuria, the mineral-bone markers, and the hemoglobin live on the same screen, so the trajectory and the metabolic picture are one glance, not a tab swap. The question of whether this patient is heading toward access planning is answered before you sit down.
Dialysis encounter templates for HD and PD
In-center hemodialysis and home peritoneal-dialysis encounter templates capture dry weight, pre and post BP, access exam, adequacy (Kt/V and URR), intradialytic events, anemia and MBD lab review, and the medication reconciliation that drives every rounding visit. Structured fields back the MCP billing rules and the comprehensive-visit cadence, so the visit count and the documentation align with what the claim has to show.
60+ lab interfaces, two-way
Quest, Labcorp, BioReference, and more than 50 hospital and reference labs feed directly into the chart. Renal panels, iPTH, phosphorus, ferritin, vitamin D, tacrolimus troughs, BK virus, and DSA panels trend automatically and route to the ordering problem. A nephrology practice lives on lab flow, and the loop closes inside the chart instead of inside the fax machine at the front desk.
Renal dose-adjustment at the point of order
Surescripts e-prescribing with EPCS, renal-dose-aware favorites for ACEi, ARB, SGLT2i, ESA, and the phosphate and potassium binders, and dose checks against the current eGFR at the moment of prescribing. The contrast-nephropathy and hyperkalemia checks fire automatically. The gabapentin that just became toxic on a creatinine of 3.4 gets flagged before it leaves your office, not after the hospital admission for confusion two weeks later.
Vascular access registry inside the chart
Access type, placement date, surgeon, maturation status, surveillance interval, and intervention history live as structured fields on the patient record. The chart shows when an AVF is overdue for a fistulagram, when a graft needs a flow study, or when a tunneled catheter is approaching its planned removal. The spreadsheet the practice manager kept in OneDrive becomes a real registry the covering nephrologist can read at 11 PM.
Transplant follow-up workflow
Tacrolimus, sirolimus, and cyclosporine troughs trend in a dedicated transplant view. DSA panels and BK virus surveillance run on the cadence the transplant center asked for. Graft function and post-transplant complications fall into structured templates, and the immunosuppression regimen sits alongside the trough trends so the rejection workup and the dose adjustment happen in the same screen.
Anemia of CKD and mineral bone disease
ESA dosing protocols, iron studies, and target hemoglobin trending sit beside the iPTH, phosphorus, calcium, and vitamin D flowsheets, with KDIGO-aligned thresholds flagged at the point of decision. Phosphate binders, calcimimetics, and active vitamin D travel inside the medication regimen, so the next titration is one click and the previous dose change is one line of context, not a hunt through three years of notes.
Hypertension management for the renal panel
Home blood-pressure intake through the portal feeds the chart before the visit, with the resistant-HTN workup, the renal-artery-stenosis evaluation, and the secondary causes templated against the way you actually think through them. The medication regimen carries the renal-artery considerations, the ACEi/ARB titration history, and the volume status notes from the dialysis unit, so the cardiology consult and the surgical referral both leave with the same picture.
Hospital ADT and inpatient discharge documents
15+ hospital interfaces deliver ADT notifications, discharge summaries, and inpatient nephrology consult notes directly into the chart. You know your dialysis patient was admitted for sepsis before the unit calls. The post-AKI follow-up clock starts on time with the discharge summary already in hand, and the chart already shows the inpatient creatinine peaks alongside the outpatient eGFR trend.
ESRD forms generated from chart data
CMS-2728 medical evidence at initiation and CMS-2746 death notification populate from the chart, with recertifications and facility-specific paperwork supported. Less faxing, less manual transcription, fewer audit findings two years later when the survey arrives. The work was always done; the chart now proves it on first request without anybody on your team reconstructing a paper trail from the whiteboard.
Rounding from the dialysis floor on mobile
Native iOS and Android apps for rounding at the dialysis unit and the hospital floor. Chart, sign, order, and capture the encounter from where the patient is. The MCP visit count updates in real time so the comprehensive visit is never missed and the partial-month visit count actually reflects the work you did, not the paper you remembered to bring back to the office on Friday.
Stone disease and PKD workflows
The metabolic stone workup, the 24-hour urine, and the prevention regimen run in their own templated workflow, with the recurrence flowsheet plotted across years. Polycystic kidney disease follow-up covers imaging cadence, tolvaptan eligibility, family-history capture, and the genetic-counseling referral, so the chart of a PKD patient looks like a longitudinal program, not a series of disconnected visits.
PRE-BUILT NEPHROLOGY CONTENT
The Nephrology Library Your Team Uses On Day One
When you log in for the first time, you do not face a blank install asking you to build a nephrology chart from scratch. The configuration is in place before training starts. Care plans, calculators, trend graphs, order sets, note templates, code favorites, smart phrases, flowsheets, decision support, screening logic, titration cards, vital captures, letters, and bilingual handouts are all wired in. Below is the short version of what runs in the background of a working nephrology practice from the first visit forward.
Care plans by CKD stage
CKD care plans by stage with ACEi, ARB, and SGLT2i optimization, diabetic kidney disease, hypertension, mineral-bone disorder, electrolyte management, and transplant follow-up. Each plan ships with the right monitoring cadence, the right titration cues, and the right patient-education attachment, so day-one care looks like year-five care for a practice that has spent a decade refining the way it manages a renal panel.
Calculators and risk tools
eGFR using CKD-EPI 2021, urine albumin-to-creatinine ratio staging, the KFRE kidney failure risk equation, corrected calcium, fractional excretion of sodium, and transtubular potassium gradient, all native and auto-scored. The risk equation that tells you whether this stage-4 patient is two years or six years from kidney failure runs at the visit, not on a separate website you have to switch to and copy values into by hand.
Trend graphs and flowsheets
eGFR slope, creatinine, potassium and bicarbonate, UACR, hemoglobin, iPTH, phosphate, calcium, vitamin D, and home blood pressure live as native trend graphs and flowsheets, each plottable across years. The eGFR/creatinine flowsheet, the electrolyte flowsheet, the UACR flowsheet, the mineral-bone flowsheet, and the hemoglobin flowsheet are the surfaces the nephrology visit actually runs on.
Order sets, note templates, and smart phrases
CKD staging-and-monitoring panel, anemia-of-CKD workup, mineral-bone disorder panel, hyperkalemia management, and pre-dialysis access evaluation as order sets. New nephrology consult, CKD follow-up, electrolyte-management visit, and transplant follow-up as note templates. Smart phrases .ckdfu, .esrdplan, and .electrolyte expand to complete templated text. Day-one nephrology runs on a real library, not a blank slate.
Decision support with KDIGO citations
Hyperkalemia alerts with severity tiers, eGFR-decline-rate alerts when the slope steepens, renal-dosing alerts at the order, contrast-nephropathy alerts before imaging, and monitoring-due alerts for the labs the care plan called for. Each alert carries the KDIGO citation it came from, so the rationale lives in the same place as the decision, configurable by role and by provider.
Letters, consents, and bilingual handouts
Transplant-referral and access-planning letters generate from the chart with the labs and the regimen already pulled in. SGLT2i and ESA prior-authorization letters assemble the documentation packet. Referring-provider result letters auto-fill from the encounter. Bilingual English and Spanish handouts cover CKD by stage, the low-potassium diet, dialysis options, and SGLT2i therapy, attached to the visit through the Education Prescriber.
GLACERCM FOR NEPHROLOGY
A Billing Service That Knows MCP, ESRD, and the Renal Code Mix
GlaceRCM charges a percentage of collections with no base fees, no implementation charges, and no monthly minimums. The service is built for the nephrology code mix, the Medicare-heavy payer panel, the MCP visit-count rules, and the access-procedure capture that a general billing team learns slowly and expensively.
95%+
First-pass claim adjudication. Most renal claims pay on the first submission, including the MCP capitation series, with no rework, no resubmission, and no calendar lost to denial follow-up.
99%+
Collection rate of payer-allowed amounts*. The dollars Medicare and the MA plan contractually owe you actually arrive, because we work the queue to resolution instead of writing it off at 90 days.
$0
Implementation fee, setup charge, and monthly minimum. We get paid when you get paid, so our interests and yours line up from the day the contract is signed.
*Of payer-allowed amounts.
MCP visit-count enforcement and stratification
The 90951 through 90970 monthly capitation series is stratified by patient age and modality, and every claim depends on the visit count being right. Our scrubber holds the rules: comprehensive-visit cadence, partial-month logic, age tiers, in-center versus home, and the documentation each tier requires. The difference between a four-visit MCP and a one-visit MCP stops disappearing because somebody forgot to count.
Medicare and MA payer-behavior fluency
Nephrology panels skew Medicare and Medicare Advantage, and each MA plan has its own denial patterns on dialysis billing, access procedures, and home-modality coverage. We work the queue every day and know which payer needs which evidence packet, which medical-necessity language, and which contact escalation actually moves a denial. The first-pass-paid claim is the cheapest claim, and that is the claim we write before submission.
Stage-accurate ICD-10 capture
The difference between N18.9 unspecified and N18.4 stage 4 is a single digit, and that digit drives both the reimbursement and the HCC contribution on a Medicare Advantage panel that should be coded at a much higher RAF than it usually lands. Our scrubber and the encounter prompts push the documented stage onto the claim. The problem list stops saying CKD unspecified five years into a relationship.
CCM, RPM, and PCM for the chronic renal panel
Chronic Care Management, Remote Patient Monitoring suited to home blood pressure and connected devices, and Principal Care Management for single-condition CKD focus all sit in the chart and accrue time against the care plan as your staff documents in the patient. The recurring revenue that a renal panel was always producing finally shows up on the claim, instead of evaporating across quarterly write-offs.
Denial management worked to resolution
We do not drop a denial after 90 days. Every nephrology claim is tracked to complete resolution: appeals, second-level reviews, payer follow-ups, peer-to-peer when medical necessity on tolvaptan or an SGLT2i is in dispute. The write-off only happens when you sign off on it. The report on your dashboard tells you exactly where every disputed dollar stands today and which appeal is on which payer’s desk.
Percentage of collections, no base fees
No setup fees, no implementation charges, no monthly minimums. We get paid when you get paid. That is the contract, in writing, on every invoice. Your interests and ours are aligned from day one, and our incentive is to collect every dollar you earned across the office E&M, the dialysis MCP, the access procedures, and the CCM line items, not to bill you for activity that did not produce collections.
A named billing specialist for your panel
You get a dedicated account manager who knows nephrology payer mix in your state, the codes you bill, and your top denials on dialysis and access. Not a ticket queue. Not an offshore call center. They pick up the phone when you call, and they know your practice by name within a month of go-live. The covering nephrologist who calls them at 4 PM on a Friday will recognize their voice on the other end.
Credentialing and payer enrollment included
Provider credentialing and payer enrollment are part of GlaceRCM onboarding, not a separate engagement and not a referral to a third-party credentialing company. New nephrologists, new dialysis-unit medical directorships, new locations, and Medicare-Medicaid revalidations are handled by the same team that runs your billing, so a new associate is billing on day one instead of waiting six months for an enrollment letter.
GLACESCRIBE FOR NEPHROLOGY
Ambient Notes That Fold Lab Trends Into the Assessment
GlaceScribe listens in the room and generates a complete nephrology note structured the way the visit actually runs: trajectory-driven HPI, the lab-trend interpretation folded into the assessment, the regimen titration laid out problem by problem, and the plan written against the stage. It is built on HIPAA-compliant AI infrastructure from Amazon, Google, Anthropic, Deepgram, ElevenLabs, and other enterprise AI providers. Multi-vendor architecture preserves operational redundancy and continuous improvement, so the scribe keeps getting better over time without ever depending on a single upstream vendor.
It learns your voice, your abbreviation patterns, and your preferred phrasing over time. The first month it sounds like a careful nephrology fellow trying to write the way you write. By month three it sounds like you. ICD-10 stage capture and CPT suggestions surface alongside the draft note, including HCC-relevant chronic conditions that came up in the conversation but were not on the active problem list. All suggestions are reviewed by you before signing. Nothing reaches the chart until you approve it, and the codes never touch the claim until you sign the note. The AI is a careful resident who hands you the note for review; the coding judgment and the billing decision stay with you.
Up to four simultaneous speakers are captured cleanly, so a spouse, an adult child, or the dialysis nurse in the room is documented alongside the patient without scrambling the assessment. The scribe runs in the office, at the dialysis unit, and on telehealth, and the same chart receives the note either way. Patient-facing language is supported in English and Spanish, so a Spanish-speaking dialysis patient gets the same encounter experience while the clinical documentation lands in English for your billing and reporting.
You will feel it most in the visits where the typing was always the bottleneck. The stage-4 patient with a six-medication regimen change. The post-hospitalization CKD-progression follow-up with a discharge summary you have to absorb in three minutes. The family meeting around the elderly dialysis patient with three adult children who all want to talk about goals of care. The rounding visit at the in-center unit where the conversation is twelve minutes of clinical detail and the documentation used to be twelve minutes of after-rounds typing. The note finishes when the visit finishes, and the lab-trend paragraph that used to take you the longest to write is the part the scribe writes best.
You can almost set a calendar by the adoption curve. Week one, you treat it as a curiosity and edit heavily. Week three, you stop editing the HPI and the ROS because they are already right; you only touch the orders and the assessment. Month three, the scribe sounds like you, including the way you talk through CKD trajectory with a newly-staged patient, the phrasing you use when you raise access planning for the first time, and the cadence of how you close a transplant follow-up. By week six, most nephrologists tell us they are getting 90 minutes to two hours of their evening back, every weeknight. The practice’s chart-completion report says the same thing, in fewer words.
POWERED BY GLACEIQ
30+ AI Features, Tuned to the Nephrologist’s Day
GlaceIQ treats every AI capability as a suggestion. You review and select. Codes wait for your approval before they touch a claim, and notes wait for your signature before they leave the chart. Compliance-first, physician-in-the-loop, every time. The list below is what runs in the background of your day on GlaceEMR, working on the cognitive load a nephrology panel carries by hand.
Pre-charting from slope, regimen, and recent labs
Before the visit, GlaceIQ assembles a pre-chart that summarizes CKD stage and slope, current renal regimen, recent lab trends with the most relevant deltas highlighted, overdue monitoring labs, hospital activity since the last visit, and last-visit plan items still open. Your MA reviews it before you walk in. The first thirty seconds of the encounter are spent on the patient, not on chart review.
Lab Interpreter against stage and trajectory
The Lab Interpreter reads results against the patient’s CKD stage and slope, not against a fixed reference range, so a creatinine of 2.6 in a stage-3 patient and a creatinine of 2.6 in a stage-2 patient surface as different signals. Hyperkalemia in a patient on an ACEi-plus-spironolactone combination triggers a different prompt than the same potassium value in a patient on neither. Suggestions surface for your review at the moment they matter.
HCC and ICD-10 capture during signing
As you sign, GlaceIQ flags HCC-relevant conditions documented in the note but not yet on the encounter’s diagnosis list, and it pushes CKD to its coded stage rather than the unspecified code. You review and select which to include. Next year’s risk-adjustment dollars stop slipping past your chart, and the Medicare Advantage panel that should code at a much higher RAF actually does, on the encounter you just finished.
Care-gap suggestions inline with the note
Overdue UACR, missing iPTH or vitamin D, patients approaching the threshold for access planning or transplant referral, anemia surveillance, mineral-bone monitoring, and the dialysis-vintage recerts. GlaceIQ surfaces them in the encounter window so you can address now, schedule for next visit, or defer with documented reasoning, in one click each. Renal surveillance becomes a managed program instead of a memory exercise.
Renal-dosing and refill safety flags
For chronic medications where the eGFR has drifted since the last review, where the patient is on a high-risk combination, or where the last office visit was more than a year ago, GlaceIQ flags the refill request for a visit before approval. The gabapentin that just became toxic on a creatinine of 3.4 gets caught, and you decide whether the refill goes out. The safety check happens before the prescription, not after the hospital admission.
Denial prediction before submission
GlaceBillSmart inside GlaceRCM scores each claim for denial probability based on payer history and code combinations, especially across the MCP series, the access procedures, and the tolvaptan and SGLT2i prior-auth-prone orders, so the billing team fixes problems before submission instead of working denials after the EOB arrives. The claim that would have failed gets the documentation it needed while you can still adjust the note.
Patient education in English and Spanish
GlaceIQ suggests stage-specific patient education for CKD, the low-potassium and low-phosphorus diet sheets, dialysis options, SGLT2i therapy, and transplant orientation, shareable to the portal in English or Spanish after you review and approve. The Spanish-speaking stage-4 patient walks out with material she can actually read, instead of a generic English handout that ends up at the bottom of a tote bag.
AI-powered prior authorization
For SGLT2i, ESA, tolvaptan, advanced imaging, and other auth-heavy renal orders, GlaceIQ assembles the documentation packet from the chart. The billing team finishes, validates, and submits. The 45-minute manual prior-auth project for a tolvaptan start shrinks to a five-minute review, and the patient with autosomal dominant PKD gets the medication their condition actually needs without a six-week back-and-forth.
Care Gap and Population Registry views
Population views surface the CKD patients whose slope is accelerating, the patients approaching the threshold for access planning or transplant referral, the dialysis vintages overdue for surveillance, and the anemia or mineral-bone labs overdue for the panel. Recall logic drives outreach through portal, SMS, or GlacePhoneSmart, turning renal surveillance into a managed program rather than a memory exercise across forty patient charts.
PATIENT ENGAGEMENT FOR NEPHROLOGY
Reach Your Renal Panel Where They Already Are
Your patient engagement stack runs on portal, mobile app, kiosk, SMS, email, and phone, with English and Spanish on every patient-facing surface. The dialysis patient on a fixed schedule, the home-PD patient who only checks the portal at night, and the elderly stage-3 patient who only answers the phone all stay engaged in the same chart, on the channel they actually use.
Practice-branded portal and mobile app
Labs, secure messaging, scheduling, bill pay, intake forms, home blood-pressure logging, and telemedicine, all under your practice name, your logo, and your colors. Patients install one app, recognize the brand on their phone, and stay there. Adoption beats the generic vendor-branded portal every time, because the renal patient already trusts the practice that has been managing their kidneys for years.
GlacePhoneSmart 24/7 line
AI phone agent answers as your practice in English or Spanish, books into real-time scheduler slots, runs recall and reminder campaigns, fills cancellations, and surfaces voicemail summaries to your staff. The front desk stops drowning in calls during peak monitoring season. Patients reach the practice at 9 PM to ask about a potassium result and still get a follow-up booked for Thursday.
SMS and email recall
CKD monitoring labs due, UACR overdue, anemia and mineral-bone follow-ups, access surveillance recalls, transplant immunosuppression trough draws, and post-AKI check-ins all run in patient-preferred language and channel, on the cadence the care plan calls for. Replies route back into the chart as structured tasks, not into an inbox somebody has to read on Monday morning.
Bilingual kiosk and renal-history intake
Self-check-in on iPad, Android tablet, or the patient’s own phone, in English or Spanish. Digital renal-history intake, home-blood-pressure intake, and dietary questionnaires populate discrete fields before the visit. The patient walks into the room ready and the rooming MA spends time on vitals, not on typing demographics off a clipboard the patient filled out twenty minutes ago.
WE KNOW YOUR CODES
We Have Billed Your Mix Before
You already know your codes. We have built the workflows, the scrubber rules, the documentation prompts, and the denial templates around them. The list below is the short version of what runs every day inside the platform for a nephrology practice:
- 99213, 99214, 99215: office E&M, established patient
- 90951–90962: ESRD monthly capitation, in-center, age-stratified, visit-count tiers
- 90963–90966: ESRD home dialysis MCP, age-stratified
- 90967–90970: ESRD daily capitation for partial-month and hospitalized patients
- 99490, 99439, 99491: Chronic Care Management
- 99424, 99425, 99426, 99427: Principal Care Management
- ICD-10 N18.1–N18.6, E11.22, I12.9, D63.1, E83.42: CKD stage-specific and complications
- CMS-2728, CMS-2746: ESRD medical-evidence and death-notification forms
SWITCHING IS EASIER THAN YOU THINK
Coming From Another EMR
Most nephrology practices we onboard are leaving a legacy EMR platform, a horizontal billing-first product, or a specialty-flat ambulatory suite that never quite fit the chronic-renal load. We have migrated all of them. The transition is the part you dread most, and it is the part we have done hundreds of times. The historical lab data, the years of creatinine values that make an eGFR slope meaningful, comes across in structured form so the trajectory is visible on day one rather than starting from a single value.
$0 implementation fee. Data migration is included in the contract: historical patient records, documents, images, active problem lists, current medications, allergies, outstanding orders, and the years of lab history that make an eGFR slope meaningful. EMR go-live in under one week of focused workflow training. RCM transition over 4 to 8 weeks with payer enrollment running in parallel, so the cashflow gap is the smallest possible. We recommend a 30 to 90 day overlap with your previous vendor while the new chart proves itself, and we plan the transition around that overlap rather than against it.
Provider training is delivered in pieces around your real schedule, not as a multi-day disruption that forces you to cancel patients or skip rounds. Your account manager runs the migration and stays your account manager after go-live, so the person who answers your call in month six is the person who set up your workflows in week one. Glenwood has been physician-founded and privately held since Christmas Eve, 1994, when our founder helped his physician wife acquire a private practice in Connecticut. 30+ years in market, no outside investors, no roadmap roulette.
Support runs 7:00 AM to 8:00 PM Eastern Time on weekdays, with 24×7 on-call coverage for urgent or critical issues, so the practice that has a problem at 6:30 AM Pacific or 10:00 PM Eastern still reaches a person. You also get unlimited online training through onboarding, included online training for new staff who join later, and a self-help library of workflow documents and videos for the moments when somebody just needs to remember how something works.
What changes on day 1, day 30, and day 90
Day 1. You log in to a chart that already holds your migrated patient history, your active problem lists, your current medication lists, your historical labs with the eGFR slope already plotted, and the recent results from your previous system. The nephrology configuration is already wired in: your templates, your order sets, your smart phrases, your code favorites, your CKD-stage care plans, your KFRE and FENa calculators, your renal-dose favorites, your access registry. You see a chart that looks like a real nephrology chart, not a blank install asking you to build one. Your first few visits run slower because the workflow is new. By the end of the first day, your hands start to remember where everything lives.
Day 30. You are charting faster than you did on the old system because the templates match the way you actually document. You are using GlaceScribe on most office visits and on most dialysis rounds, and your HPIs no longer slow you down. Your first month of CCM time has rolled into a claim, your first MCP cycle is on the dashboard with the visit counts you actually performed, and your CMS-2728s for new ESRD starts have generated from the chart instead of off a fax sheet. You and your account manager have done the first formal walk-through of the denial queue together. The recall and care-gap workflows are live, and your front desk is starting to fill tomorrow’s schedule from the recall list rather than from whoever calls in.
Day 90. Your first quarter’s RCM dashboard shows the new shape: cleaner claims, faster posting, fewer denials parked in the 60-90 bucket, MCP capture aligned with the rounds you actually did. CCM, RPM, and PCM are now real revenue lines on your books that did not exist on the old system. Your HCC capture on the Medicare Advantage panel is climbing because the encounter is finally coding CKD to its stage. GlacePhoneSmart has visibly cut your front-desk call volume, and your recall campaigns have closed care gaps for patients you would not have reached otherwise. The switch starts paying for itself, and the conversation with your account manager turns from migration triage to optimization, the parts of the platform you are ready to use harder next quarter.
QUESTIONS WE HEAR EVERY WEEK
Nephrology Practice FAQ
The questions below come up in almost every discovery call with a nephrology practice. Short answers below; the longer conversation happens on the demo. Tap any question to expand the answer.
Does GlaceEMR handle the MCP 90951–90970 series natively?
Yes. The dialysis encounter templates capture the comprehensive visit, the partial-month visits, the in-center versus home modality, and the patient age stratification, and the scrubber holds the MCP rules across the entire 90951 through 90970 range. The visit count updates in real time from the dialysis-unit rounding tool on iOS and Android, so the comprehensive visit is never missed and the partial-month code actually reflects the rounds you did. The difference between a four-visit and a one-visit MCP stops disappearing into the gap between paper rounding sheets and the billing claim. CMS-2728 at initiation and CMS-2746 at death generate from chart data, and recertification paperwork is templated against the facility-specific requirements your contracted unit asks for.
How does GlaceEMR handle CKD staging and the eGFR slope?
eGFR is calculated using the CKD-EPI 2021 equation and the CKD stage is updated automatically from the most recent creatinine and demographics. The slope is plotted across years and surfaces in the encounter window at every visit, alongside proteinuria, electrolytes, hemoglobin, and the mineral-bone markers. The KFRE kidney failure risk equation runs natively for the patients where the slope question becomes a planning question. Progression flags show up in the chart, not in a separate report you have to remember to pull, so the conversation about access and transplant referral starts when the curve tells you to start it, not when the lab value is already in the 20s.
Is GlaceScribe HIPAA-compliant, and where does the AI run?
Yes, fully HIPAA-compliant. GlaceScribe runs on HIPAA-compliant AI infrastructure from Amazon, Google, Anthropic, Deepgram, ElevenLabs, and other enterprise AI providers, all under business associate agreements. The multi-vendor architecture preserves operational redundancy, so a single upstream incident does not stop your visits, and it keeps the platform able to adopt the next generation of voice and language models as they ship. Up to four simultaneous speakers are supported, English and Spanish patient-facing, and all coding and order suggestions surface for your review before any signing. Nothing reaches the chart until you approve it, and nothing carries your signature until you sign it. Audio is processed in transit, the resulting note is stored in your single-tenant chart database, and the data never trains a shared model that mixes your patients with anybody else’s. LUKS full-disk encryption protects data at rest, alongside encryption in transit, role-based access control, and a full audit trail on the record.
What does the GlaceRCM pricing actually look like in practice?
You pay a percentage of what we collect. No base fees, no implementation charges, no setup fees, no monthly minimums. The exact percentage depends on your code mix, your payer panel, and your volume, and you will have it in your hand after a 20-minute discovery call. The contract is straightforward: we get paid when you get paid. You will not see a surprise line item for credentialing, for denial follow-up, for prior auth, for patient statements, or for the call center your patients use to ask about their bills, because all of that is part of the service. The 95%+ first-pass adjudication and 99%+ collection rate of payer-allowed amounts are how we operate across our active client base, including across the MCP series and the access procedures. If your current biller is running below those numbers on dialysis billing, what we charge tends to pay for itself out of the dollars you start collecting that you were quietly writing off before.
Do we have to switch EHRs to use GlaceRCM?
Yes. GlaceRCM is a bundled service that includes GlaceEMR clinical software, the practice management software that runs scheduling and charge capture, and the medical billing team that works your claims to resolution. The billing service runs inside our platform because the quality of the billing depends on the quality of the integration: real-time eligibility, claim scrubbing tuned to the actual chart documentation, MCP visit-count enforcement, denial root-cause analysis that closes the loop back to the encounter. We do not run our billing service on third-party EHRs because we have spent thirty years learning that hybrid setups produce hybrid results. The good news is that the switch is well-rehearsed: EHR go-live is under one week, data migration runs 2 to 4 business days and is handled by Glenwood, implementation is $0, and the 30-to-90-day overlap with your prior vendor protects continuity. If you want our software without our billing service, GlaceEMR is available standalone for the small minority of practices that prefer to keep their existing billing team. About 98% of Glenwood clients choose the bundled GlaceRCM path.
How does the platform support transplant follow-up and access surveillance?
Transplant follow-up runs as a dedicated workflow inside the chart. Tacrolimus, sirolimus, and cyclosporine troughs trend in a transplant-specific view that sits alongside the immunosuppression regimen, so the dose and the level live on the same screen. DSA panels and BK virus surveillance run on the cadence the transplant center asked for, with monitoring-due alerts when a recheck is overdue. Graft function and post-transplant complications fall into structured templates. Vascular access tracking covers type, placement date, surgeon, maturation status, surveillance interval, and the intervention history per patient, so an AVF that is overdue for a fistulagram or a graft that needs a flow study surfaces in the encounter window. The spreadsheet your practice manager kept in OneDrive becomes a real registry the covering nephrologist can read at midnight.
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