Our expert molecular lab billing services achieve a 95%+ clean claim rate and 20% average revenue increase, helping labs, genetic testing facilities, and physicians streamline revenue cycles while focusing on patient care.
Billing for molecular diagnostics and genetic testing labs comes with unique challenges that can slow revenue, increase denials, and create compliance risks:
Complex CPT and HCPCS codes
Molecular pathology CPT codes (81200–81479), NGS panels (81445–81455), and PCR tests (87635) often confuse.
Frequent denials
Common denial codes include CO-50, CO-97, PR-96, and CO-16, often due to missing prior authorization or documentation gaps.
Compliance requirements
Adhering to CLIA, CMS, OIG, and CAP standards is mandatory.
Prior authorization & payer-specific rules
Navigating coverage policies for NGS, PCR, and genetic tests can be complex.
Delayed reimbursements & high A/R
Inefficient RCM workflows lead to lost revenue and administrative burden.
Facing any of these issues? Let’s discuss.
We provide comprehensive, compliance-driven molecular diagnostics reimbursement solutions, covering all aspects of laboratory billing:
Merged per requirement
a 72-hour clean claim submission for NGS, PCR, and genetic testing with automated status tracking, denial prevention, and payer follow-up.
Expert handling of PLA codes vs CPT, molecular pathology codes, NGS panels, and PCR testing aligned to payer rules and medical necessity standards.
Real-time benefit checks and authorization workflows to prevent denials before testing is performed.
Root-cause denial analysis, payer-specific appeals, and documentation defense for high-value molecular claims.
Reduced A/R days (20–30 average) with transparent reporting on collections, denials, and payer performance.
Streamline lab workflows, improve claim accuracy, and reduce administrative overhead.
Align billing with MIPS, MACRA, and CLIA standards for incentive optimization.
We follow a proven, technology-enabled workflow that drives faster payments and fewer rejections:
AI identifies payer-specific denial patterns across claims.
Denials are categorized and routed to specialists instantly.
RPA tools auto-populate appeal forms and upload documents.
Insights are used to prevent repeat errors and update payer rules.
Our clients report up to a 40% reduction in A/R days after implementing our denial workflow.
Every claim passes through CLIA, CMS, OIG, and CAP checks to ensure payment integrity and audit readiness.
Our compliance team conducts:
This provides your lab stays fully compliant and penalty-free while meeting all MACRA/MIPS quality benchmarks for incentive eligibility.
Our approach ensures efficiency, transparency, and reliability at every step:
A single point of contact for smooth communication.
Epic Beaker, Cerner, Meditech, Sunquest, LabWare, and others.
AI-driven scrubbing tools prevent claim denials before submission.
Stay compliant and informed with actionable insights.
Outsourced molecular lab billing services tailored to lab volume.
Frequently Asked Questions (FAQs)
Accelerate payments and streamline your molecular lab billing!
