Pathology and Laboratory Medicine represents a cornerstone to the diagnosis and treatment of disease with Pathology focusing significantly on cancer.  It is reported that over 70% of all decisions in a hospital are driven by the work of "Path and Lab".  It is a significant specialty that is not interested in the limelight but critical to taking care of patients.  

Table of Contents

  1. Overview of pathology billing
  2. Eligibility and Verification
  3. Coding
  4. Denials and AR
  5. Patient collections


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Overview of Pathology Billing

Whereas most specialties can speak to the challenges of billing and collections, the Pathology and Laboratory space requires levels of detail and specificity that take the average practice management situation to new heights.  It is in those details billing teams must be diligent each day in securing the most compliant results in a very highly regulated Laboratory industry.  In its simplest form, the process breaks into 8 major components:  IT/Data, Coding, Demo/Charge Entry, Rejections, Cash Posting, Denial Management, Patient Services (Inbound and Outbound), and A/R follow up.  
Does every billing company or team do basically the same thing?  Yes.  But it is HOW you execute these components of process that make all the difference in results. In Path & Lab, the small dollar value of transactions presents the greatest opportunity and challenges to do a better job, as it means pinpoint accuracy and focus makes all the difference in yielding cash for clients.  This is an industry that requires surgical focus in managing the complex field of processes, transactions, and resources.
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Eligibility and Verification

Anchoring Demo/Charge Entry is the increasing need to not only perform eligibility checks to verify insurance but also to secure pre-authorization of testing.  A trend that has been advancing for over 5 years, the work done upfront to legitimize claims is the back-bone of collecting more money, more quickly.


Though different RCM clients “need” varying levels of coding support, Coronis’ PDM division has always taken the stance that every anatomic pathology and clinical interpretation case requires a complete review for correctness of CPTs, Dx Codes, documentation, units, and modifiers, including the differentiation of some specifics by payers.  This level of detail provides Pathology practices with a back-stop for busy pathologists who need help to verify these details, as well as supporting revenue recognition through the hour glass of a strict compliance process.  This approach makes all the difference in the world.

2019 CPT coding changes for pathology

Denial Management and AR

This is where a pathology practice’s or lab's margin can most significantly improved.  Rejections upon claims submission must be worked tirelessly.  Denials and suspicious payment levels at the time of Cash Posting require exacting focus to ensure claims are paid and paid properly.  Finally, following up on submitted claims is often overlooked or simply not a focus by  so many RCM companies and in house billing teams but it is an area that when focused on proves great results.

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Patient Collections

Though most RCM companies and in house billing teams talk about A/R follow up, however often the follow up is lacking effort and does not produce results. When it comes to patient collections, many are simply sending statements waiting for the patient to take the initiative to call. In pathology patient collections provides a unique set of circumstances in that patient  typically has no interaction with the pathologist. Therefore when they receive a statement asking them to pay, there is confusion on why they are being asked to pay a provider they have never interacted with. It is crucial that the pathology group be proactive in making outbound calls to patients in order to not only collect payment but also to educate the patient on what the charges are for. That makes a remarkable difference not only in financial results, plus it makes patients feel special that someone cared enough to call to see if they had questions or needed information.