The Clinical Laboratory Billing process is the interaction between a clinical laboratory or pathology group and the payer. Clinical lab billing can take several months to complete; and starts with laboratory coding. Diagnosis and procedure codes are assigned once a lab service is completed. The next step is the revenue cycle management or the lab collections stage where the payer is billed. Once the payer processes the claim, if approved, the claim is then reimbursed based on a pre-negotiated rate. Denied claims are sent back to the provider, who must then make the required changes and resubmit the claim. This process of exchanging claims and denials can be repeated multiple times till a claim is paid in full or until the provider decides to accept an incomplete reimbursement.
Reimbursements for clinical lab billing have been tightening while the costs for labs are on an increase. MedConverge understands the challenges, change in regulations and issues that clinical labs face. Our certified coders and experienced billing specialists are knowledgeable in the services offered by clinical labs, such as biological, hematological, cytological, etc., the rules for in as well as out of network billing, and are familiar with the latest medical technology, ICD-10 and CPT codes.
MedConverge can handle all aspects of your clinical laboratory billing, and can assist in creating a customized billing strategy specific to your organization. Contact us at for more information.