Clinical Pathology Laboratory Billing
Pathology Laboratory Billing Services
Billing for pathology laboratory services is challenging, particularly for labs with growing volume or those looking to increase their volume. Not only must billers have an extensive understanding of pathology's many subspecialties, including cytopathology, toxicology and hematology, but they must keep abreast of the numerous changes to CPT codes, CCI edits, and federal and commercial billing guidelines. If billers struggle in any of these areas, a pathology lab will likely see a rise in denials and potentially leave substantial money on the table.
To make matters worse, health insurers are increasingly narrowing their provider networks. As a result, more pathology labs are finding themselves designated as out-of-network providers and struggling to receive proper payments for services delivered.
PGM has extensive experience with pathology laboratory billing. We will work with your practice to identify and overcome problems, such as an out-of-network designation, that can result in slowed or lost payment, and educate your practice on best-in-class billing practices. Labs nationwide count on our team of certified medical billing and coding experts to ensure the paperwork necessary to get paid is received and accurate, modifiers -26 and -TC are used appropriately, and that accession numbers are in proper order to help ensure maximum reimbursement.