Laboratory Billing Specialists
Laboratory Billing Services
PAMA rates, LCD compliance, ABN management, and CLIA-aware billing for independent and physician office labs.
Lab billing operates under a completely different regulatory framework than physician billing. PAMA fee schedules, Local Coverage Determinations, Advance Beneficiary Notices, and CLIA compliance all intersect in ways that create significant revenue risk for labs without specialized expertise.
Common Challenges
Where Labs & Diagnostics practices lose revenue
Local Coverage Determinations (LCDs)
Noridian's LCDs define which ICD-10 codes justify each test for Medicare. If the diagnosis on the requisition doesn't match LCD criteria, the claim is denied as not medically necessary — regardless of clinical appropriateness.
ABN compliance
When a test doesn't meet LCD criteria, an ABN must be issued to the patient before the test is performed. ABNs issued after the fact, or used as blanket waivers, are non-compliant and create liability.
Molecular and toxicology audit risk
Molecular diagnostic and urine drug testing are among the most scrutinized areas in lab billing. Incorrect code levels, missing prior authorizations, and documentation gaps are common and costly.
What's Included
Everything your Labs & Diagnostics practice needs.
We handle the full revenue cycle for labs & diagnostics practices — from eligibility verification and coding through claims submission, AR follow-up, and denial recovery. One team. Full transparency.
Talk to Our TeamReady to fix your Labs & Diagnostics billing?
Get a free revenue cycle assessment — we'll show you exactly where the gaps are and what it would take to fix them.
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