Smart Laboratory Billing Services for Independent and Hospital Labs
Solutions360 offers billing services to lab clients including clinical labs, testing centers and pathology labs throughout the US. We understand your lab codes, payer regulations and the forms insurance companies require. You do the test, we get the payer to pay.
Why Laboratory Billing Requires Specialized Expertise
Where we take in the ordering doctor’s instructions, a lab receives a nurse or doctor’s orders. A lab doesn’t interact with a patient, so all it has to go on is what the ordering clinician supplies. Each test has to be coded exactly, have an explicit rationale and be appropriate for the payor’s requirements. Then there are frequently-changing government mandates, where one small error can be costly.
- Tons of codes. Pictured above: Labs use CPT, HCPCS, PLA and ICD-10 codes. And each has to be the test.
- Medical necessity: Payers will only reimburse if the diagnosis justifies the test.
- Charges for claims are impacted by federal rules and regulations, such as CLIA, PAMA, HIPAA and NCCI edits.
- Data entry error: an inaccurate, approximate or missing number/description from the test order can prevent payment.
Services We Handle
Our billing and coding services begin with verification of insurance benefits and coverage, prior authorization and an evaluation of each test order. Medical coding, charge entry, claim scrubbing and electronic claims transmission follow, with payments posted and applied to your claims, denials processed through management and appeals as we continue our collection efforts.
We also provide patient billing and payments plans, client and doctors’ office billing, payer credentialing and registration, compliance monitoring, billing audits, LIS and EHR integration assistance and reporting and revenue monitoring.
Why Clinics Trust Us
- Lab-only know-how: Our coders handle lab claims day in, day out. So the rules are familiar.
- We apply all HIPAA, CLIA, PAMA and NCCI edits on every single claim.
- Every claim is reviewed for mistakes prior to issuance.
- We pay claims promptly and follow an agreed schedule.
- Your billing and lab systems are synced.
- Simple-to-viewer reports: View A/R denials, payments and days in the A/R.
- Secure with customer data: Throughout our process we adhere to HIPAA regulations.
- Free billing review: We review your previous claims and let you know what was missed.
Our Performance Metrics
Providers
Procedures We Support
We bill for all types of lab tests: standard and complex blood panels, specialized molecular testing. Our coders assign the correct code to each test and ensure payer rules are followed. We support hospital and physician office labs, independent labs and reference labs.
Standard blood tests, like CBC and metabolic panels.
- Lipid panels and cholesterol testing
- Urinalysis
- Venipuncture and specimen collection
- Clinical chemistry and hematology
- Microbiology and culture testing
- Immunology and serology testing
- Pathology, histology and cytology
- Molecular diagnostics
- Genetic and genomic tests
- Toxicology and drug screening
- Infectious disease testing, including PCR tests
Common Occupational Therapy Billing Challenges
- Wrong or missing codes: A code that is similar to the correct one but not the correct one. The test requested was not appropriate for the diagnosis.
- Test orders entered without all the information such as: test orders without patient information, signed or diagnosis code.
- Bundling and NCCI conflicts: Billing tests together that payers prefer billed as a bundle.
- Significant PAMA rate adjustments: Shifts in Medicare lab test payment rates that are difficult to follow.
- Pre-authorization gaps: Tests conducted before payer approval.
- Duplicate and Repeat testing denials Claims that were denied due to the same test being billed too frequently.
- Unworked denials: Disputed claims that nobody has time to appeal.
Our Billing Process
Step 1
Practice Assessment
We review your billing workflow to identify inefficiencies, errors, and revenue gaps.
Step 2
System Integration
We connect with your EHR and practice management systems for seamless data exchange.
Step 3
Coding & Claim Management
We ensure accurate coding, clean claim submission, and timely claim follow-up.
Step 4
Payment Tracking
We track every claim through payment, resolution, or necessary follow-up.
Step 5
Issue Resolution
We quickly address denials, payer issues, and outstanding balances.
Step 6
Optimization & Reporting
We monitor performance and provide clear reports to continuously improve your revenue cycle.
Frequently Asked Questions
Does our office have the correct CLIA certificate to perform our tests?
Yes, if our office has the correct CLIA certificate to perform the tests we order. We can assist you to verify this.
Can you support me if I don't have an LIS at my lab?
Yes, we can work based on your test orders and reports as you are making a decision.
What is the deadline to file a lab claim?
It varies by payer and as little as 90 days for some. You have your payer contract with the details of the actual limit.
Can you help with old unpaid lab claims?
Yes we do examine aging accounts and appeal what is still recoverable prior to payer deadlines.
Ready to Find the Money Your Lab Is Missing?
Provide us some recent claims and our lab billing team can identify the leaks in your payments. No cost, no lengthy contract, no pressure, just straight-forward answers.
Get your Free Billing Review