Specialized pathology medical billing services with expert CPT coding, CLIA compliance, and denial management. Our certified billing professionals handle anatomic and clinical pathology claims recovery, A/R follow-up, and complete revenue cycle management.
Pathology billing requires specialized expertise in dual coding systems, anatomic pathology (88000-88399), and clinical pathology (80047-85999). Our certified coders navigate surgical pathology levels (88300-88309), immunohistochemistry (88342-88346), molecular diagnostics (81000-81479), and cytopathology (88104-88199), ensuring accurate complexity-based coding.
Proper ICD-10 coding establishes medical necessity for every test. We expertly apply critical modifiers: -26 (professional component), -TC (technical component), -90 (reference lab), and -91 (repeat testing). Missing or incorrect modifiers cause the majority of pathology claim denials; our expertise protects your revenue from these preventable errors.
MIPS determines Medicare payments through four performance categories: Quality (30%), Cost, Improvement Activities (15% large practices, 50% small), and Promoting Interoperability (25%). Pathology labs must report six quality measures and complete IA attestations to avoid penalties and earn maximum incentives.
Our MIPS specialists handle pathology-specific quality measures, including Barrett’s esophagus documentation, prostatectomy report completeness (pT, pN, Gleason score, margins), and MMR testing recommendations. We manage data collection, measure selection, and timely CMS submission, protecting your Medicare reimbursement from payment adjustments.
Your lab’s revenue cycle depends on CLIA compliance, accurate documentation, and optimized front-office (insurance verification, authorization) and back-office (coding, claims, payment posting) procedures. Medical credentialing and CLIA certification numbers on claims are essential; missing CLIA numbers trigger CO-16 denials immediately.
Our expert denial management addresses CO-4 (missing modifier), CO-16 (lacks CLIA/information), CO-97 (bundling issues), and CO-167 (medical necessity) codes. With narrow provider networks and stricter payer policies, you must verify eligibility before services, maintain HIPAA-compliant documentation, capture charges from your LIS accurately, and conduct systematic A/R follow-up.
Expert pathology billing with CPT coding, CLIA compliance, and A/R management. Streamline your revenue cycle and boost growth by up to 30%.
Pathology billing is the most complex in healthcare. Labs struggle with dual coding requirements, anatomic pathology (88000-88399) and clinical pathology (80047-85999), while managing technical versus professional component splits. Single cases involve multiple specimens requiring different CPT complexity levels (88300-88309), each needing accurate ICD-10 codes to establish medical necessity.
Common challenges include missing modifiers (-26, -TC) causing immediate denials, CLIA certification number omissions triggering CO-16 rejections, bundling errors resulting in CO-97 denials, and medical necessity failures (CO-167). Molecular diagnostics demand prior authorization, narrow provider networks create out-of-network issues, and keeping current with annual CPT updates, payer LCDs, MIPS reporting, and HIPAA compliance overwhelms internal teams.
MedCare MSO solved these challenges for pathology practices, reducing their claim denials by 30% (from 22% to 5%) and increasing cash flow by 35% through systematic A/R follow-up, proper modifier application on every claim, and real-time insurance verification. Another lab’s LIS-integrated billing improved charge capture by 20% and reduced lost revenue by 15%.
Our certified coders (CPC, CCS) expertly handle all pathology coding complexities, surgical pathology levels, immunohistochemistry per-antibody billing, molecular diagnostics with gene-specific codes, and cytopathology. We manage denial codes (CO-4, CO-16, CO-97, CO-167) with systematic appeals, ensure CLIA/HIPAA compliance, optimize MIPS reporting, reduce Days in A/R from 42 to 25-30 days, and maintain 95%+ clean claim rates.
Our pathology billing services achieve 95%+ clean claim rates through multi-level scrubbing, accurate CPT/ICD-10 coding, and proper modifier application. We reduce days in A/R from the industry average of 42 days to just 25-30 days, accelerating your cash flow and eliminating revenue delays. Every claim is submitted correctly the first time with complete CLIA certification and medical necessity documentation.
Experience faster reimbursement cycles with our aggressive A/R follow-up and systematic denial management. We handle CO-4, CO-16, CO-97, and CO-167 denials immediately with expert appeals and supporting documentation. Our real-time insurance verification prevents front-end denials before they occur.
MedCare MSO provides comprehensive pathology billing services, ensuring complete CLIA, HIPAA, and MIPS compliance while maximizing profitability. Our certified medical billing professionals (CPC, CCS) possess specialized expertise in anatomic and clinical pathology coding, preventing compliance issues before they occur. We identify and address regulatory challenges proactively, protecting your lab from audits and penalties.
We perform aggressive claims follow-up, effectively collect on aging A/R accounts to recover lost revenue, and submit accurate, timely claims for consistent cash flow. Our LIS-integrated technology automates charge capture, reducing errors and capturing every billable service.
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