CLINICAL LAB
BILLING SERVICES
ALL SPECIALITIES
- Hepatology Billing Services
- Cardiology Billing Services
- Urology Billing Services
- Oncology Billing Services
- Nephrology Billing Services
- Podiatry Billing Services
- Psychiatric Billing Services
- Clinical Lab Billing Services
- Psychology Billing Services
- Rheumatology Billing
- Medical Clinics Billing
- Surgery Billing Services
- FQHC Billing Services
- Traumatology Billing
- Rehab Billing Services
- Prostheses Billing Services
- Dermatology Billing Services
- Pulmonology Billing
- Immunology Billing Services
- Thoracic Surgery
- Cardiology Medical Billing
- Neurology Medical Billing Services
- DME Medical Billing Services
- OB-GYN Billing Services
- Nursing Home Billing Services
- Disability Billing Services
- Endocrinology Billing Services
- Ambulatory Surgery Center Billing Services
- Wound Care Billing
- Toxicology Lab Billing
- Geriatrics Billing Services
- Pediatric Billing Services
- Gastroenterology Billing
- Molecular Laboratory Billing
- Ophthalmology Billing Services
- Radiology Billing Services
- Hematology Billing Services
- Pain Management Billing
- Internal Medicine Billing
- Hospice Medical Billing Services
- Home Health Billing Services
Get in Touch
Clinical Lab Billing?
Clinical laboratories are facing a range of problems, including increased inspection, escalating operational cost, and lower payments. These issues have made it progressively challenging for labs to achieve financial stability, especially in a competitive environment with significant client turnover. To stay resilient, it is more important than ever to optimize billing workflows and strengthen documentation processes to recover costs effectively and safeguard profitability.
Many labs felt an initial shock wave in 2014 when the Protecting Access to Medicare Act (PAMA) was signed into law, and again in 2018 when new payment rates became effective. But with additional restrictions and reporting requirements, as well as deeper PAMA payment cuts on the horizon, clinical labs are bracing for the full impact. For many small and medium labs, it will prove difficult to make a profit, and some may struggle to break even. This is especially true when you consider the existing challenge of obtaining insurance contracts and receiving appropriate reimbursement. Narrowing insurance payments and issues collecting patient payments only make matters worse
Complex Coding
Clinical billing services involves navigating a complex array of CPT codes, many of which differ subtly based on the type of provider delivering the service. For instance, a distinct CPT code is required to differentiate evaluations conducted by medical providers from those performed by non-medical providers. This complexity often leads to errors by inexperienced coders who may struggle to recall and apply the appropriate codes when completing claim forms.
Additionally, clinical billing frequently involves the use of add-on codes, which are mandatory but only valid when paired with a specific primary code. Omitting an add-on code or pairing it incorrectly can lead to claim denials, causing delays in reimbursement.
To avoid such issues, it is essential for clinical lab billing services professionals to have a thorough understanding of these codes, ensuring accurate and complete claim submissions. Proper training and meticulous attention to detail can greatly reduce errors and improve billing outcomes.
For most clinical laboratories, the situation doesn’t have to be so bleak. Implementing timely and effective improvements in both front-office and back-office workflows can significantly impact outcomes. Submitting claims with precision and thoroughness is more vital than ever for the success of your laboratory. It’s essential that CPT and ICD-10 codes are not only accurate but also detailed to the highest level of specificity to establish medical necessity effectively. And time is of the essence – the limited window for reporting clinical diagnoses and submitting claims means you may have to adjust the pace of your administrative and clinical lab billing processes. This can especially be challenging when the ordering provider sends a requisition with missing, incomplete, or incorrect information.