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Specialty billing

Laboratory medical billing

Laboratory billing is high-volume and thin-margin, so screening for medical necessity before submission matters far more than appealing afterwards.

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What we handle for laboratory practices

Panels, medical necessity checks and high-volume claim submission.

Panel coding

Panels billed as panels where a panel code exists.

Medical necessity

Orders checked against coverage policy before the claim goes out.

Patient notices

Advance beneficiary notices issued where coverage is unlikely.

Volume processing

High-volume electronic submission with reconciliation.

Common pitfalls

Where laboratory claims go wrong

These are the errors we look for first when reviewing a practice in this specialty. If any sound familiar, a billing review will tell you what they are costing.

  • Component tests billed individually where a panel code exists, which payers treat as unbundling.
  • Tests performed without a diagnosis on the order that supports them.
  • Repeat or distinct specimens billed without the modifiers that distinguish them.

Not sure where your revenue is leaking?

Book a free review. We will look at your recent claims, denial patterns and A/R aging, and tell you what we find — whether or not you work with us.