If you’re running a lab, you already know how complex and ever-changing the billing landscape can be. Reimbursement rules shift constantly. Coding gets updated. Payers deny claims for reasons that don’t always make sense. And the financial health of your lab can hinge on how well those claims are handled.
That’s exactly why more laboratories are turning to billing partners who specialize in this space. Not just medical billing companies, but laboratory billing companies with deep experience in the challenges and nuances unique to your world.
And if you are evaluating vendors, it is essential to understand what truly sets the best apart, so you choose one that delivers the quality of service and support your lab deserves.
Here’s what to look for when choosing a lab billing company — and why specialization isn’t a luxury, but a necessity.
1. Specialized Expertise in Laboratory Billing
Not all billing is created equal. The rules that govern laboratory billing are very different from those affecting service providers like physician practices or ambulatory surgery centers. And within the lab space itself, things can get even more nuanced.
For example, billing for molecular labs involves staying on top of complex CPT coding and frequent payer policy updates. Clinical labs often face challenges with volume-based claims and evolving Medicare policies. Pathology labs have to juggle technical versus professional components. And toxicology labs are under growing scrutiny when it comes to medical necessity and documentation. Naturally, many of these challenges overlap across lab types.
A great lab billing company doesn’t just understand these differences. It thrives in them. The company’s team speaks the language of labs. They’ve seen the denials, navigated the audits, and built systems to optimize reimbursement for tests just like those you’re doing in your lab.
That kind of focus matters. A lot. Because when it comes to ensuring accurate payments, maximizing your collections and minimizing compliance risk, there’s no substitute for experience and expertise.
2. Transparent Reporting and Open Communication
Top lab billing companies act like true partners (more on this concept of a “true partner” below). They don’t just send reports and disappear. They keep you in the loop, explain what’s happening with your claims, and help you understand your numbers and the meaning behind them.
You should feel confident that your laboratory billing team is not only working hard behind the scenes, but also sharing the kind of insights that can help you improve. And help you help them. Whether it’s a sudden uptick in denials, a payer slowing down reimbursements, or a coding update that could affect your revenue, a strong outsourcing partner will make sure you know what’s going on and what to do about it.
Good communication isn’t just about access to data. It’s about clarity, context, and responsiveness.
3. A Track Record With Labs Like Yours
When evaluating potential billing partners, don’t be shy about asking for real-world examples. The strongest companies will have experience supporting labs that look a lot like yours — not just in general terms, but in the specifics.
Ask whether they’ve worked with your type of testing. How they’ve handled payer issues in your region. What kinds of results they’ve delivered for similar labs.
A billing company that’s helped a molecular lab clean up coding and cut denials in half, or supported a toxicology lab through an audit while maintaining cash flow, will be far more prepared to support your lab’s growth and challenges.
4. End-to-End Support That Fits Your Workflow
Some labs want full-service revenue cycle management. Others just need help with a few specific areas. The best lab billing companies offer flexible, tailored solutions that fit your workflow rather than forcing you into theirs.
Maybe your team handles intake and eligibility, but needs expert help with coding and appeals. Or maybe you’re looking to outsource everything so your staff can focus on testing and growth.
Whatever the case, look for a partner who’s ready to meet you where you are, and capable of scaling with you as your needs evolve.
5. Lab Billing Compliance Expertise You Can Rely On
In lab billing, compliance isn’t optional — and getting it wrong can lead to denied claims, delayed payments, audits, or worse.
That’s why it’s critical to work with a billing company that treats compliance as a core priority. They should understand Office of Inspector General (OIG) guidelines, stay current with federal and payer-specific requirements, and help you implement best practices that protect your lab long-term.
This is especially important if your lab is performing services in high-scrutiny areas like toxicology or molecular diagnostics. The right billing partner will help ensure you’re not just getting paid — you’re getting paid correctly and compliantly.
6. Technology That Makes Billing Easier, Not Harder
Today’s best billing companies bring more than just people. They bring smart systems. Look for platforms that make it easy to integrate with your lab’s existing systems.
You shouldn’t have to dig through spreadsheets or wait days for updates. Real-time visibility, clean dashboards, and secure file sharing are all part of the modern lab billing experience.
It’s not about tech for the sake of tech. It’s about technology that gives you clarity and control, all without making you feel like you need an IT degree.
7. A True Partner Mentality
Ultimately, your billing company should feel like part of your team. They should ask smart questions about your lab, offer strategic advice, and be easy to reach if and when you need them.
The best outsourcing lab billing vendors won’t just process claims. They’ll think ahead, solve problems before they become urgent (or even before they become actual problems), and work with you to improve performance over time.
If you get the sense that a vendor is more interested in volume than in real partnership, trust your instincts — and keep looking.
Choose Your Lab Billing Company Carefully. It Matters!
The stakes are high when it comes to billing. Your lab’s cash flow, compliance, and ability to grow all depend on doing it right. That’s why it’s so important to take the time to evaluate potential billing partners carefully.
Talk to a few vendors. Ask about their experience with molecular, clinical, pathology, and toxicology lab billing. Dig into their processes. And don’t just take their word for it — ask for examples, referrals, and results.
After going through that process, many labs ultimately choose PGM Billing. That’s because we bring more than just expertise. We bring a commitment to collaboration, performance, and helping labs thrive. Whether you’re just starting your search or narrowing your options, we’d love to be part of the conversation.