What we handle for pathology practices
Billers are assigned by specialty, so the person working your claims already knows your codes and your payers.
Anatomic pathology
Surgical pathology levels billed to specimen complexity, with correct unit counts per specimen.
Clinical pathology
Laboratory panels billed within payer bundling rules and CLIA scope.
Molecular and genetic testing
Billed with correct codes and the medical necessity documentation payers require.
Component splits
Technical, professional and global billing set correctly for each client arrangement.
Where pathology claims usually go wrong
These are the four issues we see most often when we take over a pathology practice.
Missing or unusable ordering diagnosis
If the ordering physician's diagnosis does not support the test, the claim denies. We chase the correct diagnosis rather than writing it off.
Specimen unit counting
Each separately identified specimen is its own unit. Undercounting is the most common pathology revenue loss.
Panel unbundling edits
Billing panel components separately triggers automatic edits and takebacks.
Molecular test coverage
Many molecular tests need documented criteria or prior authorisation before they will be paid.
How we work
Eligibility, every day
Every next-day scheduled patient is verified for active coverage before the visit.
Charges validated
Codes and documentation are checked after the note is signed, before the claim is submitted.
Denials appealed
Every denial is reviewed, corrected and resubmitted. Nothing is written off by default.
Monthly reporting
Paid claims and AR aging reports so you can see exactly where your money is.
Pathology billing questions
Something not covered here? Call (833) 305-5528.
Do you handle client billing arrangements?
Yes, including global, technical-only and professional-only depending on the arrangement.
Can you chase missing diagnoses from ordering physicians?
Yes. That work is included rather than treated as an exception.
Do you bill molecular and genetic testing?
Yes, with the documentation those tests require.