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
Guide: Navigating PCR Billing Challenges in MolDx Jurisdictions
Laboratories performing polymerase chain reaction (PCR)-based diagnostic testing continue to face significant billing and reimbursement challenges, particularly in regions covered by the Molecular Diagnostic Services Program (MolDx). As labs operating in these areas…
No Surprises Act Frequently Asked Questions
The No Surprises Act (NSA) provides individuals and families covered by group and individual health plans protection against unexpected, high-priced medical bills for services delivered at in-network facilities by out-of-network (OON) providers.
3 Things to Know When Billing for Genetic and Molecular Testing
As labs throughout the country continue to explore new revenue streams in the face of seemingly endless annual cuts from CMS and commercial payers, many are adding genetic testing and molecular diagnostics to their test menus. However, due to a patchwork of regional...
Denial Management
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evolving list of MUEs, especially when considering CMS and other carriers reserve the right to maintain a list of unpublished MUEs that providers and their billers likely won’t know about until they receive a denial.
Medical Billing Audit Unlocks $20K in Claims After Cyberattack
As we look back at recent trends, 2024 may go down as the year of the cyberattack. In February of last year, the Change Healthcare breach made national headlines as the largest healthcare cyberattack in history, halting claims submission and disrupting payments across the country.
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...
CMS Fee Schedules
What’s Standard for Medical Lab Billing Contracts?
Entering into an agreement for medical billing services is an important process for any clinical lab or pathology group that does not have this service provided by a hospital or other partner. But what metrics and capabilities should a medical group or lab look for...
Is My Lab Required to Report PAMA Data?
Originally put into effect in 2017, the Protecting Access to Medicare Act (PAMA) requires many labs to report private payer data for clinical diagnostic lab tests to CMS every three years. The data is used to determine median payments in an effort to bring the...
The importance of TC Modifiers in Pathology Professional Component Billing
As we continue to optimize our clients’ billing practices, it is crucial to ensure they have a clear understanding of the use of the TC (Technical Component) modifier, especially in situations where a pathology group bills only the PC (professional component) and is...
