Revenue Cycle Management Solutions
Comprehensive RCM Consulting for Laboratories & Pathologists
Lighthouse Lab Services delivers high-impact revenue cycle management consulting and auditing by uncovering and fixing billing issues that drain revenue or threaten compliance. From charge creation to explanation of benefits (EOB), our experts ensure your lab gets paid what it’s owed.
Laboratory Billing & Auditing
We specialize in in comprehensive revenue cycle audits, revenue cycle process optimization, and managed care contract negotiation. While we are not a billing company, our experts utilize a three-tiered process of assessing revenue strategy, management, and providing insight to help clients find weaknesses and strengthen billing processes.
We help our clients recover millions of dollars in lost revenue each year due to incorrect coding.
By specializing and working with laboratories and pathologists, our team knows industry trends and key payer issues that are affecting health providers today.
We Review and Analyze
Entire Revenue Cycle
Denials and Trends
Monthly Charges
Payer Contracts
How We Help
Private Laboratories
We help private, reference, and physician-owned laboratories align testing menus with front-end processes to ensure correct and consistent reimbursement and coding.
Hospital Systems
Lighthouse assists hospital systems in reviewing specialty group contracts, FMV for pricing, coding/billing audits for ancillary groups, staffing levels, fee schedules, and more.
Specialty Practices
We build tailored revenue strategies focused on compliance, coding accuracy, and improved billing workflows so you capture every dollar you’ve earned.
Case Studies
We love to show off the results of our hard work. Check out the case studies below for a few examples of our recent successes.
Payer Policy Errors
A major payer misapplied its own policy. We spotted the error and helped the client recover over $200,000 in unpaid claims.
Payer Contracting
Our routine coding review uncovered gaps that led directly to seven new managed care contract opportunities.
Document Requests
Stumped by denials or request for additional documentation? Check out our recommended best practices for navigating PCR testing requiements.
Billing Terms
Curious about industry standards and norms for third-party billing contracts to ensure agreements are fair? Check out this fact sheet for a breakdown.
Thought Leadership and Video Resources
Billing and Coding Best Practices for Digital Pathology
Safeguarding Lab Revenue Against Ongoing Reimbursement Cuts
Current Pathology Coding Errors and How to Avoid These Mistakes
Get a free laboratory billing consultation
Are you billing all the correct CPT codes? You’d be surprised at what you might be missing. We will review your Fee Schedule for free. Schedule a Complimentary ConsultationWhen you need a complete picture of your laboratory revenue cycle, Lighthouse RCM Solutions offers an end-to-end solution to find errors that jeopardize your compliance and affect your revenue.
MolDx Billing FAQs
How should I approach payers who require Z-codes regardless of the state when MolDx does not issues codes for a particular service, such as UTI PCR Testing?
If MolDx does not issue Z-Codes for UTI PCRs, but UHC or Humana requires them, you must still register the test with DEX to obtain a Z-code, even if it’s not a MolDx jurisdiction.
Has anyone had success billing large PCR panels (UTI, RPP, Wound, Fungal infection, etc with 15+ targets) in CA without Z-Codes?
In California (a MolDx jurisdiction), Z-Codes are mandatory for large panels like UTI, RPP, Wound, etc. Billing without them will likely result in denials.
Is there a proposed timeline for all MACs to join MolDx?
There is no current indication that they intend to join MolDX, but the trend suggests increasing adoption of MolDx-like policies by commercial payers. Stay updated via CMS and Palmetto GBA announcements
For Moldx, do Medicare Advantage plans through commercial payors follow commercial or Medicare guidance?
UHC, Optum Care, and Humana are the Medicare Advantage payers that currently require a Z-code on molecular tests. Other Medicare Advantage plans do not currently require the Z-code. https://www.dexzcodes.com/palmetto/dex.nsf/DID/HU3Y1NXU26
What should I bill when CMS and AMA coding guidance conflict? Such as CPT 887798
CMS appears to be interpreting CPT code 87801 as a single test, regardless of how many organisms are tested or how many results are reported. Their stance is that if one kit is used, it constitutes one test.
However, if you closely examine the definition of 87801, it refers to a single test with a single result—which is not reflective of current practice. In reality, multiple individual results are often reported from one panel.
This is why the AMA guidance recommends unbundling the codes. According to CPT nomenclature, panels such as UTI, STI, or wound panels should be billed using individual codes for each organism tested, since each yields a separate result.
That said, CMS—and possibly other payers—are pushing back. In recent audits, particularly those related to UPIC, CMS has stated they will only reimburse 87801 when one kit is used, regardless of the number of organisms tested. Unfortunately, this is their policy. We agree that this approach is not ideal. Unfortunately, at this time, providers are absorbing the financial impact.
Related Consulting Services
Our team of laboratory and pathology billing specialists can help transform the way you manage your revenue.
Lighthouse RCM Solutions will work closely with you to implement the checks and balances needed to improve your bottom line and secure the future of your practice.
