Lab & Pathology RCM Insights
Revenue Cycle Management
For lab owners and RCM leaders, staying current on reimbursement and shifting rules is critical for financial success. Learn what’s changing across payers and discover proactive steps to optimize your revenue cycle.
Browse articles and resources by category below. Click here to see all RCM updates.
Billing & CPT Coding
Molecular Test Reimbursement: MolDX, Z-Codes & Payer Reform
If you work in a clinical or molecular lab, you’re living this tension every day: advancements in testing keep moving forward, but reimbursement rules lag months or even years behind.
Understanding and Navigating Medicare MUE, PTP Edits
As with most CMS initiatives, it can be difficult to keep pace with the constantly evolving list of MUEs, especially when considering CMS and other carriers reserve the right to maintain a list of unpublished MUEs that providers and their billers likely won’t know about until they receive a denial.
Pitfalls to Avoid When Using Diagnosis Z-Codes
Lighthouse billing and coding specialists have recently observed a rising trend of claim denials for laboratory services involving the Z00.00 diagnosis code. This code, which is used for general adult medical examinations without abnormal findings, often needs to be...
Denial Management
How Clinical Labs Can Improve Payer Network Access and Leverage
For independent and small- to mid-sized reference labs/POLs, one reality remains consistent: laboratories fail for two primary reasons. Either they cannot get enough samples in the door, or they cannot get paid for the work they perform.
Molecular Test Reimbursement: MolDX, Z-Codes & Payer Reform
If you work in a clinical or molecular lab, you’re living this tension every day: advancements in testing keep moving forward, but reimbursement rules lag months or even years behind.
Balancing Compliance, Risk, and Revenue in Toxicology Testing
For many labs, toxicology has long been a top target for payer audits. Reimbursement cuts and stricter “medical necessity” interpretations are raising denials, claw-backs, and scrutiny, especially around frequency of testing and documentation quality.
CMS Fee Schedules
6 Tips for How to Get In Network with Insurance Companies
Has your lab or group encountered obstacles when trying to determine how to get in network with insurance companies who represent your patient population? If so, you’re not alone. Health insurance companies manage their provider networks in a variety of ways and under different strategies.
Case Study: Using Billing Data to Bolster Lab Contract Negotiations
Overview A leading laboratory client was initially offered a reimbursement rate of 100% Medicare for their commercial policies. Given that commercial payors typically reimburse significantly higher than Medicare rates, accepting this offer would have left substantial...
How Pathology Groups and Labs Can Advocate for Better Compensation
Pathology and laboratory services are vital to clinical decision-making, from routine diagnostic testing to guiding complex cancer care. Yet, these professionals increasingly feel the squeeze from declining reimbursements and rising operational costs. For both...
