MedCare MSO’s pathology billing software automates charge capture, AI powered CPT/ICD coding, TC/PC split billing and denial management. It is purpose built for anatomic, clinical and speech language pathology labs.
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By processing same day ERA's and reconciling every day, you'll reduce the number of days in Accounts Receivable by up to 35%. As soon as you post the remittances, payments will show as posted and make your accounts receivable up to date.
All denials post with the original CARC Codes, such as co-97 (bundled), co-16 (missing info), co-22 (other payer), co-50 (medical necessity), and the PR series (responsible for the Patient). This provides your denial management team with clean data for appeals.
With each posting, you will receive the original ERA / EOBS images, trace numbers (EFT's/checks), and CARC/RARC codes as well as timestamps and notes from the specialists. This provides you with complete documentation for payer audits and compliance reviews.
Our analysts identify when allowed amounts fall below contracted fee schedules, when multiple procedure reductions exceed agreement terms, and when bundling edits are applied incorrectly. Underpayments are flagged for reprocessing.
We ensure operations never get delayed due to volumetric spikes, employee turnover, or vacation coverage by managing any lost productivity and maintaining an ongoing business as usual workload; thus, ensuring that your entire revenue cycle remains productive.
Accurate posting and patient statements reflect the actual balance due after deductibles, coinsurance, copays, and non-covered services are itemized separately. By providing accurate statements, the number of denied claims falls considerably.
The software connects to your LIS and pulls accession numbers, specimen types, ordered tests and final pathology diagnosis in real time. No manual re entry is required.
AI reads pathology reports and auto generates billable charges. It suggests CPT codes, ICD 10 diagnoses and appropriate modifiers. It includes TC / PC splits for every case and every specimen.
Before any claim goes out AI checks for NCCI edits, payer rule conflicts, missing codes, invalid combinations and duplicate submissions. It catches errors that would trigger denials.
Claims are submitted electronically via 837p / 8371 through your clearinghouse. AI tracks payer responses, flags denials for action and feeds every outcome into your revenue analytics dashboard.
Manual pathology billing routinely misses charges on add-on tests, IHC stains and multi-specimen cases. Our billing software for pathology auto-captures every billable line item from every case. It includes biopsy, frozen section, molecular and cytology as well so no procedure goes unbilled.
A single coding error in pathology billing even a missing modifier, an invalid TC/ PC combination or an incorrect ICD 10 can trigger a denial that costs $40-$120 to fix. Our AI-powered claim scrubbing catches these errors before submission. Payer rule intelligence keeps your claim logic updated without manual policy tracking.
Electronic claim submission, automated batch processing and clearinghouse integration shorten the time between specimen sign-out and reimbursement. With real-time AR aging dashboards and automated denial submission workflows. Pathology groups often see payment cycles shorten by 30% or more within the first 90 days.
Our billing pathology software is purpose-trained for the full spectrum of pathology and lab billing.
The software automatically converts pathology case data into billable charges. It ensures no procedure, add on test or specimen goes unbilled.
AI reads pathology reports, diagnosis details and specimen information to suggest accurate CPT, ICD 10, HCPCS and modifier codes.
Before claims are sent system automatically checks for any missing or incorrect information. This helps increase clean claim rates and lowers denials.
With electronic claim submission, clearing house integration and batch claim processing claims move faster from lab sign out to payers claim submission.
The software automatically handles technical and professional component billing including revenue splits by provider or facility.
It integrates with your LIS and pulls live case data directly into billing workflows. This removes duplicate data entry and saves hours of manual administrative work.
General medical billing software is not built for the complexity of pathology billing. Our pathology billing software includes specimen level billing logic and NCCI edit rules specific to laboratory services.
The AI reads pathology reports and diagnosis notes using NLP to extract specimen type, test performed, stain type, complexity level and diagnosis. It then maps these for correct and accurate codes to match payer requirements.
Absolutely yes. Our software is built for scale. It supports batch claiming processing, automated charge capture from high volume LIS feeds and multi site lab billing from a single instance. No matter if you deal 50 or 50,000 cases per month the system maintains it’s accuracy.
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