Laboratories billing
Laboratories billing,
without the denials.
Labs bill thousands of small claims, and each one depends on a diagnosis someone else chose. We check medical necessity and coverage rules up front, so tests aren't denied after the work is done.
What makes it hard
Where laboratories revenue gets lost.
Medical necessity
Each test must be linked to an ICD-10 diagnosis that the payer accepts for it. National and local coverage determinations list covered diagnoses for many tests.
ABNs
When a test is likely not covered, Medicare requires an Advance Beneficiary Notice before the specimen is collected if you want to bill the patient.
Panels and bundling
Tests that make up a panel must be billed as the panel when all components are performed, and NCCI edits bundle many lab codes.
Missing order data
Orders often arrive without complete demographics, insurance or diagnosis codes, and every gap blocks the claim.
How we handle it
Checks built into every claim.
Our team and the GetMax platform apply these checks before claims go out, not after the denial comes back.
- Diagnosis-to-test coverage checks against NCD and LCD rules
- ABN tracking for tests that need one
- Panel and bundling edits before submission
- Missing order data chased with the ordering provider
Frequently asked
Questions we hear a lot.
Why are lab claims denied for medical necessity?
Usually because the diagnosis on the order is not one the payer accepts for that test. Checking the diagnosis against the coverage rules before billing prevents most of these denials.
Does a lab need a CLIA number on claims?
Yes. Medicare and many other payers require the lab's CLIA certificate number on claims for laboratory services.
Keep reading
Other specialties.
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Learn more →Let's look at your laboratories numbers.
Tell us your payer mix and your biggest headache. We will show you what we would change.