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Keep CKD Patients on the Follow-Up Your Nephrologists Set
Find CKD patients past the follow-up interval your nephrologists set, labs ordered and never drawn, referrals never scheduled, and patients who may qualify for care management.
What is nephrology revenue intelligence?
Nephrology revenue intelligence finds kidney patients who have fallen behind the care your nephrologists planned: CKD follow-up past the stage-based interval they set, labs and imaging never completed, referrals never seen, and outbound access or transplant orders with no visit. Nuvory is healthcare revenue leakage intelligence; it ranks these patients and routes possible CCM, PCM or RPM candidates to clinician review.
Where does a CKD panel leak visits and labs?
Nephrology is longitudinal care. Most revenue comes from regular visits and programs over years, so leakage looks like a patient who quietly stopped coming.
CKD follow-up overdue
Patients past the visit interval their nephrologist set for their stage and risk.
Learn moreLabs and imaging not completed
Kidney function labs, urine studies and renal ultrasound ordered before a visit and never done.
Learn moreInbound referrals never seen
Primary care and hospital referrals for declining kidney function that never reach a first visit.
Learn moreCare management candidates
CKD patients with diabetes, hypertension or other chronic conditions who may be candidates for CCM, PCM or RPM.
Learn moreOutbound referral orders open
Orders your nephrologists placed for vascular access or transplant evaluation with no visit on record.
Learn moreMissed visits not rebooked
No-shows and cancellations with no new date, including post-hospital visits where discharge information reaches your EHR or a connected HIE feed (Enterprise).
Learn moreWhy do kidney patients quietly fall behind?
Kidney patients fall behind because CKD is often silent. Many patients feel fine between visits, have several other specialists, and see labs as something their primary care doctor handles. When a visit is missed, nothing prompts a new one until the next abnormal result.
Follow-up depends on the patient's stage and risk, and your nephrologists set the interval. A stable patient may be seen less often; a patient with declining function more often. Recall lists rarely reflect those differences, so staff cannot tell which overdue patient matters most.
Labs are part of the visit. A nephrologist often wants kidney function and urine studies before the appointment. If the patient skips the draw, the visit may be rescheduled, and a reschedule that is not rebooked becomes a gap. Outbound referrals for vascular access or transplant evaluation are also hard to track, because the visit happens at another organization.
- Stage-based intervals One recall rule for every CKD patient hides the ones who need attention first.
- Pre-visit labs A skipped lab draw can cancel or delay the visit.
- Care across organizations Access surgery, transplant centers and dialysis units each keep their own records.
See which CKD patients have fallen behind
Book a nephrology demo and we will show how Nuvory finds overdue CKD follow-up and care management candidates in a practice like yours.
How does nephrology revenue intelligence track stage-based follow-up?
Nephrology analytics software can tell you how many CKD patients you have; Nuvory tells you which ones are overdue and why. It reads diagnoses, lab orders and results, visits, referrals and care program enrollment from your EHR every night. It compares each CKD patient's last visit with the follow-up your nephrologist set, checks whether ordered labs were drawn, and looks for patients not enrolled in a care program who may be candidates. Patients already booked are left off the list.
- Diagnoses and stage CKD and related conditions as recorded on the problem list.
- Lab orders and results Ordered kidney function and urine studies, drawn or not.
- Visits and recalls Last visit, next visit and the recall your clinicians entered.
- Referrals and orders Inbound referrals with no contact after 7 days or no visit after 14; outbound orders with no visit recorded.
- Care program status Current CCM, PCM or RPM enrollment, so enrolled patients are not flagged again.
Does Nuvory decide when a patient needs access surgery or a transplant referral?
No. Those are clinical decisions made by your nephrologists with the patient. Nuvory only shows when an order your nephrologist already placed has no visit on record, based on available data, so staff can check on it.
Which continuity metrics should a nephrology practice track?
Nephrology metrics should show continuity over years, not visit counts in a month. Visits completed after detection are compared with your baseline as a correlation, not a causal claim.
| Metric | What it shows |
|---|---|
| CKD follow-up on schedule | Patients seen within the interval their nephrologist set. |
| Pre-visit labs completed | Ordered labs drawn before the visit. |
| Referral to first visit | Inbound referrals that reach a first visit. |
| Care management candidates | Nephrology care management opportunities surfaced, reviewed and enrolled with consent. |
| Outbound orders with a visit | Access and transplant evaluation orders with a recorded visit. |
| Missed visits rebooked | No-shows and cancellations with a new date. |
How do schedulers, nurses and care managers split the work?
Nephrology teams are small and stretched. Nuvory gives each person a short list instead of a recall report.
- Clinical reviewerA nephrologist signs off each rule, including how stage-based intervals are read, after spot-checking real patients.
- Referral coordinatorWorks inbound referrals with no contact, as part of nephrology referral management.
- SchedulerWorks overdue CKD follow-up and missed visits, ranked by estimated value, urgency and confidence, and books the lab draw and the visit together where your workflow allows.
- Nurse or MAFollows up on undrawn labs and open outbound orders before the next visit.
- Care management leadReviews CCM, PCM and RPM candidates with clinicians. Nothing is enrolled without clinician approval and patient consent.
- Practice administratorTracks recovered visits and program growth against a baseline.
Grow care management from the patients you already see
See how Nuvory surfaces CKD patients who may be candidates for CCM, PCM or RPM, ready for clinician review.
How does Nuvory work with nephrology EHRs and care management platforms?
Nuvory works alongside your EHR, lab interfaces and any care management platform you use. It does not replace them, and it is not a care management service on its own; it finds the patients and the plan stays with your clinicians. Nuvory is designed to work with data from athenahealth, where the connection is live, and from eClinicalWorks, Epic and other supported EHRs through FHIR R4 APIs and, where the EHR supports it and your organization enables it, bulk export and SMART on FHIR. Scope and data availability are confirmed during discovery.
Care management candidates can be handed to your own team or to HealthArc's care team on the HealthArc platform. Either way, clinicians decide. See security for how patient data is protected.
What should a nephrology practice ask before choosing a tool?
Ask whether a tool respects stage-based intervals your nephrologists set, tracks pre-visit labs, keeps every care management decision with clinicians, and handles care delivered at other organizations.
Further reading
Finding CKD Follow-Up Gaps in a Nephrology Practice
CKD patients rarely leave a nephrology practice on purpose. They miss a lab, a visit slips, an outside referral goes quiet. Here are the five gap types, how to find each one and who should work them.
Revenue LeakageCCM, PCM, APCM and RPM eligibility explained: finding candidates without adding staff
How CMS describes CCM, PCM, APCM, RPM and related programs, which signals make a patient a candidate for clinician review, and how to run that review queue.
Revenue LeakageThe Most Common Revenue Leaks in Specialty Medical Practices
From referrals that never get scheduled to procedures canceled and never recovered, these are the revenue leaks specialty practices see most often, with what each looks like, why it happens and how to find it.
Questions, answered
More in our FAQ, or ask our team.
Does Nuvory stage CKD or set follow-up intervals?
No. Nuvory reads the diagnoses and recalls your clinicians record. Your nephrologists stage disease and set intervals, and your clinical reviewer signs off how Nuvory reads them. Nuvory does not diagnose.
How does Nuvory find CCM or PCM candidates in nephrology?
Nuvory looks at recorded diagnoses, visit history and current enrollment to find patients who may be candidates for CCM, PCM or RPM. Every candidate goes to clinician review, and nothing is enrolled without clinician approval and patient consent. Clinical validation may be required.
Can Nuvory track labs drawn at outside labs?
Yes, where results reach your EHR or a connected feed. Otherwise staff can close the item as done elsewhere with a reason.
Does Nuvory track dialysis or transplant referrals?
Nuvory can show when an outbound order your nephrologist placed, such as for vascular access or transplant evaluation, has no visit on record, based on available data. It does not decide timing or readiness; that is a clinical decision.
Is Nuvory a nephrology patient recall tool?
Recall Intelligence is part of it. Nuvory also covers referrals, open orders, missed visits and care management candidates, ranked together in one list on the Growth plan.
How is Nuvory priced for a nephrology practice?
Starter is $149 per provider per month for Recall Intelligence. Growth is $299 per provider per month and adds Referral, Procedure, Scheduling, Care Management and Opportunity Intelligence. See pricing.
See Nuvory with a nephrology workflow
Book a nephrology demo to see overdue CKD follow-up, open labs and care management candidates for your practice.