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
IHC Reimbursement Under the Microscope: What Pathology Groups Need to Know
Payment and coverage for immunohistochemistry (IHC) stains are facing increased scrutiny from both commercial and government payers. For pathology groups and laboratories, this heightened attention has translated into several areas to watch.
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evolving list of MUEs, especially when considering CMS and other carriers reserve the right to maintain a list of unpublished MUEs that providers and their billers likely won’t know about until they receive a denial.
Denial Management
What is MolDX and When Do I Need a Z-Code?
Laboratories performing infectious disease testing and billing Medicare Part B within a MolDX jurisdiction are subject to a 2022 Local Coverage Determination (LCD) that significantlys impact reimbursement for these services.
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.
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...
Lighthouse Acquires MJB Lab Consulting, Expanding Medical Leadership Services