Laboratory Billing Billing
Specialized coding and billing for independent and clinical labs.
The Challenge
Common Billing Challenges in Laboratory Billing
Laboratory billing is driven by strict coverage policies, PAMA pricing rules, and frequent LCD changes. General billing teams often miss the nuances that lead to denials, underpayments, and compliance gaps.
PAMA Pricing Compliance
Medicare requires strict adherence to PAMA-mandated pricing for clinical diagnostic lab tests, updated annually.
ABN Requirements
Tests not covered by Medicare for a given diagnosis require an ABN — missing one shifts liability to the practice.
LCD Coverage Limitations
Local Coverage Determinations restrict which diagnoses support specific lab tests — billing outside these limits triggers automatic denials.
Reflexive and Panel Testing
Billing reflexive tests and panels requires careful CPT selection and documentation of medical necessity.
Our Approach
How TBL MedRCM Solves It
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