Expert Laboratory Medical Billing Services
For over a decade, Pulse Medix has partnered with independent clinical labs, hospital outreach programs, and reference labs to create one of the most efficient lab billing, coding, and financial management services available. We help labs manage high-volume, low-value claims, enhance collection rates, and obtain valuable revenue cycle management insights through detailed financial reports.
Our team collaborates closely with you to develop a tailored billing strategy that aligns with your laboratory’s strategic business goals. Our comprehensive laboratory medical billing service addresses all aspects of billing, including both technical and professional components, for both in-network and out-of-network services. Here’s how:
- Collection of payments made by payers directly to patients
- Integration with Laboratory Information Systems (LIS) and other data systems
- Monitoring patient encounters to ensure all cases are submitted for reimbursement
- Ensuring payments align with contracted rates
- Appealing denials of molecular laboratory claims classified as investigational
- Billing patients for their balances
- Addressing patient inquiries about billing
- Providing pricing guidance
- Ensuring accuracy in financial reporting, coding, billing, and collections
- Increasing revenue while efficiently handling high-volume, low-dollar claims
- Offering regulatory guidance
Get in touch with us today to discuss the unqiue needs of your practice and get a personlized solution!
We Cater to a Broad Range of Medical Laboratories
Order and Demographic Management
Toxicology
Molecular Diagnostics
Clinical Laboratories
Pathology
Our Key Performance Indicators
24/7 Customer Support Availability
30% Reduction
in A/R
91% First Pass Clean Claims Rate
90%+ Collection Ratios
20-30% Revenue Increase
7-14 Days Turnaround Time
Our Comprehensive Lab Billing Services
1. Medical Billing & Coding
According to the AMA, over 50% of claims submitted by laboratories contain incorrect codes. This problem is worsening for laboratories because new CPT/PLA codes can’t keep up with fast molecular testing advancements. When using “unspecified” codes, it is crucial to provide precise descriptions, “Z” codes, and proper documentation. Inaccurate and inconsistent coding can lead to undercharging, overcharging, and post-payment audits.
At Pulse Medix, we conduct a comprehensive practice evaluation for all our clients. Our certified coders, alongside our reimbursement specialists, review practice procedures and coding to provide recommendations that ensure accurate and optimal reimbursement.
2. Charge Upload
According to the AMA, over 50% of claims submitted by laboratories contain incorrect codes. This problem is worsening for laboratories because new CPT/PLA codes can’t keep up with fast molecular testing advancements. When using “unspecified” codes, it is crucial to provide precise descriptions, “Z” codes, and proper documentation. Inaccurate and inconsistent coding can lead to undercharging, overcharging, and post-payment audits.
At Pulse Medix, we conduct a comprehensive practice evaluation for all our clients. Our certified coders, alongside our reimbursement specialists, review practice procedures and coding to provide recommendations that ensure accurate and optimal reimbursement.
3. Claim Audits
We gather and review all patient and charge data from clients. Billing uploads and batches are balanced, and our medical claims processing software ‘scrubs’ claims to detect and correct errors. This software conducts thousands of checks, including CPT/ICD-10 validations, modifier checks, demographic comparisons, and payer-specific edits.
This thorough claims review process ensures that laboratory billing data is accurately captured and that claims are error-free before submission. Clean claims significantly boost payment rates, maximizing collections and reducing accounts receivable.
4. Claim Submission
After the claims are reviewed and audited, they are transmitted to various payers for reimbursement. We can electronically submit claims to thousands of payers nationwide. For payers that cannot receive electronic claims, Pulse Medix will generate and mail paper claims.
Once submitted, our clearinghouse performs an additional level of “scrubbing.” Any edits and errors are sent back to us for correction before final submission to the payer.
5. Payment Posting
Payments are received either in hard copy or via electronic fund transfers (EFTs). The corresponding explanation of benefits (EOBs) are received as hard copies or electronic remittance advices (ERAs), which Pulse Medix retrieves directly. Our clients can choose to continue receiving payments at the laboratory or allow us to manage all payments at one of our facilities.
Upon receiving payment, one of our reimbursement specialists reviews and posts each line item into our practice management system.
6. Denial Management
Most medical practices receive payment for only 70% of their insurance claims. Even if a practice submits a flawless claim to a payer, there’s no guarantee it will be paid or paid accurately. Payers often introduce complex rules and systems to limit payments, leaving practices unpaid for their valuable services to patients.
Our independent laboratory billing services offer a fee structure based on incentives and ensure thorough follow-up to avoid missing payments. When an outstanding claim is identified as overdue, our system alerts our account representative, who then reviews the history and takes appropriate action to follow up on the claim.
7. Patient Balances
We collaborate directly with laboratories to create a customized patient billing profile and handle all patient billing tasks for them.
A standard patient billing profile includes a series of clear and simple statements. If a patient does not make a payment, additional letters are sent, and a call sequence is initiated. Patients with billing questions can call a toll-free number, where our billing specialists are available to assist.
8. Reporting & Analytics
Pulse Medix’s laboratory billing software offers clear, real-time visibility into claim status and lab operations. Labs can access our cloud-based revenue cycle management software, allowing them to view and manipulate data at various levels. You can filter and sort data by almost any field or data point. From accession reporting to sales force performance, our reporting engine is designed to boost your bottom line and return revenue control to your business.
Perks of Choosing Our Independent Laboratory Billing Solutions
Advanced EMR/EHR Software
Our advanced billing software reduces errors and ensures accurate claim submissions, leading to timely payments.
Real-Time Data Access
Real-time visibility into claim statuses and laboratory operations through our cloud-based system. It enables you to make informed decisions quickly.
Staying Updated with Coding Changes
Our lab billing services are designed to grow with your laboratory. We offer scalable solutions that are adaptable to increasing volumes and complexity.
Optimized Revenue Cycle Management
Our comprehensive revenue cycle management services streamline billing processes, helping to maximize collections and minimize accounts receivable.
Faster Reimbursements
Streamlined processes and efficient claim management lead to quicker reimbursements. The results? Improved cash flow and financial stability.
Our Success Stories
Don’t just take our word for it; explore the success stories of our clients who achieved a revenue boost of up to 30%.
Take Control of Your Laboratory Billing Today!
Maximize efficiency, ensure accuracy, and accelerate reimbursements with our expert solutions. Contact us now to get started!