Pathology CPT Codes
Insights on CPT Codes
Are you billing all the correct CPT codes? You’d be surprised at what you might be missing. Learn below the latest rules and regulations from our team of medical billing experts.
Read the latest updates on Pathology CPT codes
Effectively Navigating Medicare TPE Audits for Clinical Labs
Medicare's Targeted Probe and Educate (TPE) program is designed to identify and reduce improper payments, enhance compliance, and educate providers on proper billing practices. While TPE audits are intended to be educational rather than punitive, receiving an audit...
7 New Payer Contracts Obtained for Full-Service Medical Lab
Overview The client is an independent medical laboratory located in the Southeast of the U.S. that has served its local community for almost seven years. It is a full-service lab including blood culture, toxicology, and molecular testing. RELATED CASE STUDY: Expanding...
Case Study: Payer Denying Lab Outreach Work Due to Policy Error
By: Beth Madden, Client Manager, Lighthouse RCM Solutions The Issue Our RCM Solutions Team often digs into denials that continually stem from the same payer in order to help our clients better understand what is creating a payment logjam while ensuring future claims...
What is MolDX and When Do I Need a Z-Code?
Information provided by Tami Shaw, Client Manager, Lighthouse Lab Services Palmetto and WPS delayed enforcement of the LCD highlighted in this article until May 17, 2022. The LCD highlighted in this article went into effect for CGS and Noridian on June 2, 2022....
Navigating Medical Necessity for PCR Testing
It's essential for referring providers considering large panel tests to grasp the nuances of Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) in order to effectively navigate medical documentation requirements. Without...
What’s Standard for Medical Lab Billing Contracts?
Update: This article was reviewed in April 2024 to update the information within and ensure figures cited are still accurate. Entering into an agreement for medical billing services is an important process for any clinical lab or pathology group who does not have this...
How Labs Should Respond to the Change Healthcare Cyberattack
In the wake of the recent Change Healthcare cyberattack, independent lab owners and pathology groups are facing critical challenges. This overview aims to address common questions and concerns related to the attack’s impact on revenue cycles, compliance, and patient...
The importance of TC Modifiers in Pathology Professional Component Billing
By: Dyana Williams, RCM Client Engagement Manager 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...
The Power of Front-End Billing Edits: A Comparative Analysis of Claim Denials
By: Dyana Williams, Client Engagement Manager Understanding and addressing claim denial reasons is crucial for the financial stability of medical and pathology laboratories. As part of a recent case study, our RCM Solutions Team delved into the denial patterns of two...