We provide specialized molecular medical billing services with the assurance of compliance of government policies and leverage return on revenue. We imply and configure the billing and coding procedures with scalability and efficiency, effectively respond to denials and rejections to execute the required annual payer adjustments and payback.

Molecular Billing Services

As a molecular (or genetic) diagnostic laboratory, you provide critical testing and services that significantly impact the way people live their lives. You offer definitive scientific results that help providers identify, diagnose, and responsibly approach medical care. Healthcare professionals understand the importance of genetic testing in preventive care and treatment options, but insurance companies haven’t been so quick to agree.

Molecular testing labs’ billing is complex in nature. For one, molecular testing can be very expensive, and payors simply don’t want to incur the costs, particularly when there isn’t a clear documented medical necessity. Credentialing issues, difficulty securing insurance contracts, and stringent CMS requirements of detailed family history are major obstacles that diagnostic laboratories face. It doesn’t help that advances in medicine and genetic testing have occurred at a faster rate than regulatory agencies have been able to keep up with, resulting in a tedious and often confusing molecular lab billing & coding process.


We Ensure Accurate Claims Submission

Medcare MSO offers specialized molecular, genetic, and diagnostic laboratory billing services to ensure claims are properly coded and submitted in a timely manner and with all supporting documentation. Our certified medical billing specialists are experts at what they do, and they stay on top of all changes to CPT codes. Our specialized knowledge and experience mean we submit accurate claims the first time and see increased collections on A/R accounts.

In all fields of laboratory billing, ever-changing Current Procedural Terminology (CPT) codes present a challenge, but they have been revised at a dizzying rate in molecular billing which makes it nearly impossible for in-house billing staff to keep up. Individual genes don’t always have their own unique CPT code, making it extremely difficult to file an accurate claim. In some cases, one code can be applied to ten different genes. In other cases, the gene isn’t specified at all, so claims have to be billed with unlisted codes. Additional MolDX coding requirements for each gene further complicate the billing process.

Complicated Procedures and Treatments Involve Complex Coding

Modifiers are an important part of cardiology billing and coding services. These additional subcategories of numerical codes are required to give the details that are required in order to be reimbursed for all services delivered. While inexperienced billers and coders can look up the general code for a procedure, they often do not know how many levels of modifiers they need to include or all the numerically coded details that need to be added. Payers are trending towards more bundling of costs into single codes, which can simplify billing—but coders must recognize any variance from the standard bundled items and know-how to itemize to avoid over-and under-coding.