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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.

Consulting & Audit Services – Revenue Cycle Management

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

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Entire Revenue Cycle

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Denials and Trends

Monthly Charges

Payer Contracts

How We Help

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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.

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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.

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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.

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Payer Contracting

Our routine coding review uncovered gaps that led directly to seven new managed care contract opportunities.

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Document Requests

Stumped by denials or request for additional documentation? Check out our recommended best practices for navigating PCR testing requiements.

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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.

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"Lighthouse has been a true ally through the years, battling the slings and arrows of the Pathology world. I can rely on them to keep up with laws and issues we face, while I focus on Pathology and patient care. They provide oversight over our billing office, which sometimes needs prodding. They have my back, and I appreciate the help."

Dr. Weiss

"When it comes to Pathology billing, Lighthouse Lab Services is the go-to expert. They will get your billing and reimbursement processes running like a well-oiled machine."

Robbie Graham, MD, Comanche County Memorial Hospital

"We partner with Lighthouse because they are always a step ahead. They have strengthened our practice with their knowledge and expertise. We appreciate their dedication and integrity!"

Lucent Pathology Partners

"Our group has used Lighthouse for many years. When we started they did an in depth investigation of our billing process and identified areas where we could make improvements and increase our monthly revenue. They took us through two different RFP processes for billing agencies and helped identify the best match for us. Through all of this they have been knowledgeable, professional, and efficient, displaying integrity by reducing their fee during our lowest months. I highly recommend them."

North Pathology Associates

"Our pathology group has been using Lighthouse's Practice Management for the past year and have been very happy with the service. For the first time I feel confident that our billing company is compliant and giving us the service we need. Lighthouse helped us renegotiate our contract with a substantial savings. They also assisted in switching to a more effective collection service. It is nice to know that help is one call or text away and that I can trust their advice."

Dr. Merle Madigan

"My 6-man pathology group has used Lighthouse for over 10 years. They originally helped us select a replacement billing service. Since then they have monitored the billing service, provided formal audits, and maintained close contact with us with regular conference calls where billing information is reviewed and a practice management plan is discussed. They have provided advice on contractual negotiations with insurance companies and have provided the perspective of being closely involved with other practices and having a national presence in the pathology business arena. I have found them to be responsive to our needs. The value added to my practice easily justifies the expense of their service."

St Vincent’s Pathology

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 Consultation

When 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.  

Mark Dietz

Business Development Manager

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.