rcm solutions Laboratories facilities

Medical Billing And Revenue Cycle Management Solutions For Laboratory (Pathology/clinical Labs) Facilities

Laboratory providers, including clinical and pathology labs, analyze bodily fluids and tissues of patients to aid in the diagnosis, treatment, and prevention of diseases. At StafGo Health, we specialize in providing customized billing and revenue cycle management (RCM) services for all sizes of pathology groups and clinical laboratories. Lab billing is very complex in nature due to the high number of claims, constantly changing CPT/HCPCS codes, and strict insurance-specific documentation requirements. Our experts align each and every step of your lab's revenue cycle, be it test order verification or charge collection, to management of denied claims and compliance tracking.

Optimizing Lab Revenue with the Right CPT Code Management with StafGo Health

The application of an accurate code is very necessary for successful reimbursement in laboratory billing in both pathology and clinical labs. Our experts handle the commonly billed codes, including CPT 80048–80076 for basic and comprehensive metabolic panels, CPT 81000–81099 for urinalysis procedures, and CPT 82040–82962 covering various chemistry tests like glucose and liver function tests. In pathology, CPT 88300–88309 is used for surgical pathology (gross and microscopic examinations), while CPT 88172–88177 covers fine needle aspirations (FNA), and CPT 88312–88325 for special stains and immunohistochemistry. For molecular and genetic testing, codes like CPT 81400–81479 are frequently used. Drug testing panels are billed under HCPCS G0477–G0483, depending on the complexity and number of drug classes screened. Our experts make sure the coding is accurate and properly done to maintain the smooth operation and reimbursements.

Why Outsource Medical Billing And RCM To Stafgo Health For Your Laboratories (Pathology/clinical Labs)?

Outsourcing your laboratory's medical billing and revenue cycle management to StafGo Health means partnering with industry experts who deeply understand the complex nature of pathology and clinical lab billing. We have a comprehensive knowledge of all the issues faced by pathology and clinical labs. Our team is proficient in managing the large number of claims, complex CPT coding, and accurate documents required in services like molecular diagnostics, genetic testing, and toxicology. Our team makes sure that accurate modifiers are being used, and you always adhere to payer-specific guidelines to minimize claim denial rates and payment delays.

Common RCM Challenges Faced by Laboratories (Pathology/Clinical Labs)

The following are some common and unique challenges associated with laboratory billing and therefore can lead to uninterrupted cash flow for your labs.

Complex Coding for High-Volume Tests- In the laboratory, a number of tests are performed every day. And every test has its unique CPT or HCPCS codes. Hence, misuse of codes, missing information, missing modifiers, or bundling errors can result in claim denials or compliance issues.
Medical Necessity & Diagnosis Linking Errors - Proving medical necessity is one of the concerns for Laboratories. Reimbursement of claims depends on the correct use of diagnosis codes linked to the test. A lack of accurate ICD-10 code pairing and documentation leads to the payer denying the claim, resulting in non-payment.
Payer-Specific Coverage Policies - Medicare and private insurance companies have different rules regarding their coverage criteria. These are called Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs), It is necessary to stay updated with these complicated and frequently changing policies.
Delays in Authorizations & Test Referrals - Getting prior authorizations for some advanced pathology tests or genetic screening is very difficult. When the authorization is not obtained on time, labs have to face the issue of forced write-off of large balances despite service delivery.
Denials Due to Missing or Incomplete Requisitions- Incomplete information on lab request forms, like missing details on referring physician data, can hold the claim for a longer period and even lead to rejections. These operational breakdowns delay reimbursement and increase the rework time.

Solving Your Laboratories' (Pathology/Clinical Labs) Practice’s Challenges with StafGo Health

At StafGo Health, our team ensures accurate CPT and ICD-10 coding, proper bundling and unbundling of lab panels, and compliance with payer-specific policies to reduce denials and accelerate reimbursements.

Accurate Test Coding & Modifier Application - We have a team of certified coders who ensure that every test is billed with the correct CPT or HCPCS code and accurate modifiers, so that denials could be avoided due to bundling issues, missing units, etc.
Diagnosis Linking & Medical Necessity Assurance - Our billing experts precisely link the procedures with the appropriate ICD-10 codes and also validate them against payer-specific medical necessity guidelines, which can significantly reduce the chances of claim rejections.
Real-Time Payer Policy Integration - Our team of professionals continuously monitors Medicare LCDs/NCDs and commercial payer policies and stays updated with the ever-evolving guidelines. We also ensure that the lab’s billing always aligns with up-to-date coverage requirements.
Prior Authorization & Referral Tracking Support - Our team proactively tracks referral data for the tests that require pre-approvals. We make sure that all payer prerequisites are met before claim submission. to avoid any kind of delay or rejection.
Automated Denial Management & Rebilling - At StafGo Health, we not only manage the denial but also leverage an intelligent RCM platform equipped with rule-based automation to quickly identify and address claim denials. Our team proactively does a deep search on recurring denial trends and tries to fix the root cause of the denials.