Outsource Laboratory Medical Billing
Managing laboratory billing is a complex and time-consuming process, requiring expertise in coding, claims submission, and revenue cycle management. By choosing to outsource laboratory medical billing, your practice can streamline operations, reduce overhead costs, and focus on delivering quality patient care.
At CLICKVISIONBPO, a trusted laboratory billing company, we specialize in providing tailored laboratory billing solutions that meet the unique needs of labs. Our team of experts ensures accurate billing, faster reimbursements, and full compliance with industry standards.
What Is Laboratory Medical Billing?
Laboratory medical billing is the specialized process of managing claims for diagnostic and clinical tests conducted by laboratories. It involves converting services into standardized codes—ICD-10 for diagnoses, CPT for procedures, and HCPCS for additional services or supplies—ensuring accuracy in claim submissions and compliance with payer policies.
This process includes essential components such as:
- Accurate Test Coding: Properly coding blood work, urinalysis, pathology, and specialized diagnostic panels.
- Claims Submission and Tracking: Preparing clean claims and managing their progress with Medicare, Medicaid, and private insurers.
- Revenue Cycle Management: Ensuring timely reimbursements, resolving denials, and maintaining compliance with healthcare regulations.
By handling these intricacies effectively, laboratory medical billing supports laboratories in optimizing revenue cycles while adhering to industry standards.
Most Common ICD-10 Codes and Associated CPT Codes in Laboratory Billing
Below is a list of common ICD-10 and CPT codes used in laboratory billing services.
| Test Type | Common ICD-10 Codes | Associated CPT Codes |
|---|---|---|
| Blood Tests | R79.89 (Other abnormal findings), E11.9 (Type 2 diabetes mellitus without complications) | 80053 (Comprehensive metabolic panel), 85025 (Complete blood count with automated differential) |
| Urinalysis | R31.9 (Hematuria, unspecified), N39.0 (Urinary tract infection, site not specified) | 81001 (Urinalysis, automated), 81003 (Urinalysis, automated, without microscopy) |
| Infectious Disease Testing | B20 (HIV disease), J02.9 (Acute pharyngitis, unspecified) | 87591 (HIV-1, amplified probe technique), 87880 (Streptococcus A, rapid test) |
| Pathology Tests | C50.919 (Malignant neoplasm of breast, unspecified), D50.0 (Iron deficiency anemia secondary to blood loss) | 88305 (Surgical pathology, gross and microscopic examination), 88342 (Immunohistochemistry, per antibody) |
| Molecular Diagnostics | Z84.81 (Family history of carrier of genetic disease), E78.5 (Hyperlipidemia, unspecified) | 81479 (Unlisted molecular pathology procedure), 81223 (Cystic fibrosis transmembrane conductance regulator gene analysis) |
| Hematology Tests | D50.8 (Other iron deficiency anemias), D68.9 (Coagulation defect, unspecified) | 85060 (Blood smear, manual), 85379 (Fibrin degradation products) |
| Hormone Panels | E23.0 (Hypopituitarism), E28.2 (Polycystic ovarian syndrome) | 83001 (Thyroid-stimulating hormone), 84443 (Thyroid hormone levels) |
| Cancer Screening Tests | C61 (Malignant neoplasm of prostate), Z12.11 (Encounter for screening for malignant neoplasm of colon) | 88350 (Tumor immunohistochemistry, HER2/neu), 81301 (BRAF gene mutation analysis) |
| Genetic Testing | Q87.1 (Congenital malformation syndromes), R62.0 (Delayed milestone in childhood) | 81205 (BRCA1 gene analysis), 81406 (Level 5 molecular pathology procedure) |
| Lipid Panel Tests | E78.0 (Pure hypercholesterolemia), E78.1 (Pure hypertriglyceridemia) | 80061 (Lipid panel), 82465 (Cholesterol, serum, total) |
Comprehensive Laboratory Billing Services
Laboratory billing involves intricate processes, including coding, documentation, and compliance with payer requirements. Our tailored solutions address the complexities of laboratory workflows, ensuring accurate billing and optimized revenue cycles. Our laboratory billing services include:
Billing for Blood Tests
Laboratories frequently conduct essential blood tests, including Complete Blood Count (CBC), Blood Glucose, Lipid Panels, and Liver Function Tests. We ensure proper coding for these tests, addressing payer-specific guidelines and documentation requirements to maximize reimbursement rates.
Billing for Urine Tests
Accurate billing for urinalysis, drug screening, pregnancy tests, and kidney function tests is critical to laboratory operations. Our team handles the complexities of coding and submission, reducing the risk of claim denials and ensuring compliance with payer regulations.
Billing for Specialized Diagnostic Panels
Laboratories often process advanced panels such as genetic testing, infectious disease panels, and metabolic panels. These require detailed preauthorization, coding expertise, and thorough documentation. We streamline the entire process to secure faster approvals and reimbursements.
Preauthorization for High-Cost Laboratory Tests
Certain high-cost diagnostics, like genetic screening or advanced imaging tests requiring lab support, often necessitate preauthorization. Our experts handle the preapproval process, ensuring that required documentation is submitted promptly to avoid delays.
Denial Management for Laboratory Services
We specialize in analyzing denied claims related to lab services, identifying root causes such as coding errors or incomplete documentation. Our proactive approach includes correcting and resubmitting claims to recover lost revenue efficiently.
Billing for Preventative Screenings
Preventative lab tests, including cholesterol screenings, diabetes testing, and cancer markers, are essential to patient care. We ensure proper coding to align with preventive care benefits under various insurance plans, reducing patient out-of-pocket expenses.
Our RCM Services for Laboratories
Our comprehensive revenue cycle management (RCM) services are designed to optimize the billing and reimbursement process for laboratories, ensuring maximum revenue while reducing administrative burdens. We handle every stage of the cycle from patient registration to final payment collection, with a focus on laboratory-specific requirements. Our key RCM services for laboratories include:
Patient Registration and Insurance Verification
Ensuring accurate demographic and insurance information is captured at the start, reducing errors and verifying insurance coverage to avoid claim denials.
Charge Entry and Specialized Coding
Properly coding laboratory tests, including blood tests, urinalysis, and molecular diagnostics, with ICD-10, CPT, and HCPCS codes to ensure accurate billing and compliance with payer guidelines.
Claims Submission and Follow-up
Submitting clean and complete claims for laboratory procedures and tests, then diligently following up with payers to ensure timely reimbursements and resolution of any delays.
Denial Management and Appeals
Analyzing and addressing denied claims by identifying errors or missing information, resubmitting corrected claims, and handling appeals to maximize payment recovery for labs.
Payment Posting and Account Reconciliation
Accurately posting payments from insurance companies and patients, and reconciling accounts to ensure proper financial tracking and transparency.
Financial Reporting and Analytics
Providing laboratories with detailed reports and insights into their revenue cycle performance, denial trends, and overall financial health, helping to identify areas for improvement and ensure profitability.
Advantages of Outsourcing Laboratory Billing
Cost-Effective Laboratory Billing Solutions
Gain access to a remote team at our company, offering competitive rates and significant cost-savings. By outsourcing, laboratories can reduce operational expenses and improve financial efficiency without compromising on quality.
Enhanced Operational Efficiency for Your Laboratory
Streamline your budget by outsourcing complex billing tasks, allowing for efficient resource allocation and reduced overhead costs. Our billing services ensure precise handling of claims, freeing your staff to focus on core lab functions.
Scalable Laboratory Billing Solutions
Easily adjust your billing capabilities to match your growth. Outsourced billing enables you to upscale operations without the challenges of hiring and training additional staff.
Dedicated Laboratory Billing Team
Rely on a team assigned specifically to your operations, ensuring tailored support and adherence to your operational policies. Our experts specialize in medical billing, guaranteeing accuracy, compliance, and seamless revenue cycle management.
Why Outsource Laboratory Medical Billing Services?
Laboratory Billing Experts
Our team specializes in laboratory billing, providing in-depth knowledge of CPT codes, ICD-10 coding, and HCPCS. We navigate the complexities of coding and documentation, ensuring compliance with regulatory requirements such as HIPAA, HITECH, and MACRA, ultimately improving accuracy and reimbursement rates.
Maximizing Revenue for Laboratory Services
We manage the entire billing cycle, from charge capture to payment posting, ensuring efficient processing. Our detailed approach adheres to payer-specific guidelines and helps optimize Medicare and Medicaid reimbursements, while also mitigating errors tied to diagnostic tests and specialty treatments.
Accuracy and Compliance
Through optimized workflows and proactive documentation review, we ensure accurate ICD-10 coding for disease classifications and CPT codes for procedural billing. Our team stays updated on payer policies, including MIPS and CDC guidelines, to reduce claim denials and audits, ensuring timely and complete reimbursements.
Affordable Laboratory Billing Services
Outsourcing your laboratory billing reduces operational costs by eliminating the need for in-house resources and infrastructure. By leveraging our specialized billing expertise, we streamline your revenue cycle management, reducing overhead costs associated with EHR systems and billing software while improving financial outcomes.
Customized Laboratory Billing Solutions
Recognizing that each laboratory has unique needs, we offer tailored billing services for services like clinical pathology and genetic testing, ensuring the most accurate coding practices and optimal reimbursement.
Ensuring Compliance and Security in Laboratory Billing
We ensure adherence to HIPAA compliance, safeguarding patient information in all billing practices. Our team also stays current with industry regulations, including HITECH Act incentives, and ensures that all data transmission and processing meet the highest standards of security and confidentiality. Compliance with Stark Law also ensures that our practices avoid referral violations and improper billing practices.
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Leadership Team
Dimitar Talevski
Dimitar is a seasoned marketing specialist and the visionary behind CLICKVISION. With over 10 years in digital marketing, he excels in crafting marketing strategies that boost rankings, which in return increase leads, conversions, sales, profits, and ROI.
Filip Dimitrijevski
HIPAA Compliance
The Health Insurance Portability and Accountability Act (HIPAA) establishes standards for the protection of sensitive patient information in healthcare environments. In laboratory billing, compliance with HIPAA ensures that personal health data (PHI) is handled securely and confidentially throughout the billing process.
Key Aspects of HIPAA Compliance in Lab Billing:
- Data security measures to protect PHI.
- Authorization and consent procedures for accessing patient information.
- Secure communication and transmission of billing data.
- Regular employee training on privacy and security standards.
- Regular audits to ensure compliance with HIPAA’s privacy rule.
CLIA Compliance
The Clinical Laboratory Improvement Amendments (CLIA) regulate laboratory testing in the United States to ensure that labs perform tests with the required accuracy, reliability, and timeliness. CLIA compliance is essential for labs to remain eligible for reimbursement from Medicare, Medicaid, and private insurers.
Key Aspects of CLIA Compliance in Lab Billing:
- Laboratories must be properly certified under CLIA to conduct diagnostic testing.
- Labs are required to meet standards for quality assurance and proficiency testing.
- Accurate documentation and record-keeping of lab tests to ensure proper billing and reimbursement.
- Adherence to CLIA standards in laboratory procedures, especially for tests used in claims submission.
| Regulatory Body/Act | Description | Impact on Laboratory Billing |
|---|---|---|
| HIPAA | Health Insurance Portability and Accountability Act | Ensures privacy and security of patient information in billing processes. |
| HITECH | Health Information Technology for Economic and Clinical Health Act | Promotes the use of Electronic Health Records (EHR) and health tech to improve billing accuracy and compliance. |
| MACRA | Medicare Access and CHIP Reauthorization Act | Transition to value-based care, impacting reimbursement models for laboratory services. |
| CMS | Centers for Medicare & Medicaid Services | Oversees Medicare and Medicaid billing requirements for laboratory services. |
| Medicare | Federal program providing health coverage | Dictates billing standards and reimbursement rates for laboratory tests under Medicare Part B. |
Payers We Work With
We collaborate with a wide range of payers to ensure timely, accurate reimbursements for laboratory services. Our expertise helps streamline the claims process and reduce denials. Key payers we work with include:
Medicare and Medicaid
We ensure compliance with government billing guidelines, minimizing delays and denials for diagnostic tests.
Private Insurers
We work with major insurers like Aetna, Blue Cross Blue Shield, and United Healthcare, ensuring accurate coding and compliance with their specific billing requirements.
Specialized Healthcare Plans
We handle claims for workers' compensation, health savings accounts (HSAs), and other specialized plans with unique billing processes.
Government Health Plans
Beyond Medicare and Medicaid, we manage billing for government health plans like TRICARE, adhering to their specific requirements.
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A specialized billing company has the expertise in handling the unique challenges of laboratory billing. They understand the intricacies of coding, insurance regulations, and payer requirements, ensuring accurate claims submission and timely reimbursements while reducing the risk of errors or denials.
Outsourcing ensures efficient revenue cycle management by reducing manual errors, improving claim tracking, and adhering to coding regulations. Our team manages the billing cycle from claim submission to accounts receivable, ensuring compliance with industry standards and timely reimbursements. This approach improves financial outcomes and operational efficiency.
We handle the entire billing process, including accurate coding, insurance verification, payment posting, and denial management. Our team ensures compliance with healthcare regulations while maintaining insights into billing performance through custom reports and comprehensive reporting systems.
We strictly follow federal regulations, HIPAA guidelines, and Clinical Laboratory Improvement Amendments (CLIA). By leveraging Laboratory Information Systems and electronic health records, we ensure proper documentation, adherence to medical necessity requirements, and compliance with ever-changing regulations.
Outsourcing reduces the administrative burden on house billing teams by handling complex billing scenarios and ensuring accurate coding. It eliminates the need for expensive billing software, reduces overhead costs, and improves financial performance through faster insurance reimbursements and improved cash collections.
Our dedicated team of billing specialists performs denial management by identifying coding errors, missing documentation, and other common issues. We resubmit corrected claims to insurance companies and maintain low denial rates through proactive audits and regular compliance checks.
Outsourcing enhances financial stability by reducing payment delays, increasing cash collections, and minimizing hidden costs. With accurate billing and improved charge capture accuracy, our solutions ensure a seamless billing experience that supports long-term business growth for laboratories.
We use advanced technologies, including billing software, automated verification systems, and Laboratory Billing Systems integrated with electronic health record platforms. These technologies reduce human errors, ensure timely payments, and provide real-time insights into collection rates and financial reports.
Outsourced billing operations improve the patient experience by simplifying billing processes, ensuring clear communication with patients, and reducing billing surprises. Our team handles patient payments professionally, allowing healthcare providers to focus on quality patient care.
In-house billing teams often face limitations due to lack of advanced technologies, rising administrative costs, and frequent manual errors. Outsourced billing services, on the other hand, offer specialized expertise, cost-effective solutions, and compliance with industry standards, ensuring better financial outcomes and billing efficiency.
Our team has extensive experience handling complex billing scenarios, such as genetic testing, advanced diagnostic procedures, and high-cost laboratory services. By ensuring accuracy in coding and compliance with billing regulations, we optimize reimbursement processes and improve cash flow for healthcare laboratories.