MOLECULAR LABORATORY BILLING

WE ARE EXPERTS IN MANAGING COMPLICATED MOLECULAR BILLING CODES

Medcare MSO provides specialized molecular medical billing services to ensure compliance with regulations and maximize revenue. Our billing process has been honed over the years until it is a highly efficient system. We respond to denials and rejections, tracking each one to ensure it is paid. We also manage the less common billing details, including handling annual payer adjustments and payback.

Molecular Labs Have Unique Requirements

Genetic testing is a rapidly developing field and one of the things that make medical billing so complicated is that the billing codes just can’t keep up. Molecular testing is providing answers to ever more questions and helping physicians make important decisions, but it can be expensive, so insurers are resistant to approving tests.
To be successful at molecular lab billing, you have to know the billing codes, but also have experience with all the details that must be included. It also helps to have experience working with insurers. A claim that is denied or rejected needs to be appealed, and there’s a much better chance of getting paid for it if your biller knows just what to tell the insurer to establish medical necessity.

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.

Constant changes in the field mean the CPT codes update regularly, making it difficult for in-house billers to keep up with the latest changes. In some cases, one code can be applied to ten different genes, but in others the gene isn’t specified so the claim has to be billed with an unlisted code. On top of that, there is another layer of management to deal with in the MolDX organizations and coding requirements.
Those facts all combine to indicate one thing: outsourcing the medical billing for molecular testing is a great solution for labs. The staff get a break from dealing with claims and the dedicated billing team at Medcare MSO gets claims paid.