Lab & Hospital Billing Services
Lab and hospital billing involves managing the complex, high-volume revenue cycles of diagnostic laboratories and large-scale medical facilities. This specialized process ensures that institutional claims—ranging from routine screenings to inpatient surgical procedures—are accurately coded, submitted, and reimbursed, maintaining the financial health of the facility.
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Advanced Diagnostic and Procedural Coding
Hospital and lab billing requires a deep understanding of specialized coding sets, including ICD-10, CPT, and HCPCS. Accurate coding is essential for reflecting the complexity of hospital stays and the specific technical components of laboratory tests, ensuring full reimbursement for services rendered.
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Institutional Claims Management (UB-04)
Unlike standard physician billing, hospital billing utilizes the UB-04 (CMS-1450) form. We manage the intricacies of institutional billing, ensuring that room charges, pharmacy costs, and ancillary services are correctly bundled and reported to meet the stringent requirements of commercial and government payers.
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Regulatory Adherence and Lab Compliance
Navigating the regulatory landscape of CLIA (Clinical Laboratory Improvement Amendments) and hospital-specific mandates is vital. Our process includes rigorous internal audits to ensure all billing practices comply with federal guidelines, reducing the risk of recoupments or legal penalties.
High-Volume Scalability
Our systems are designed to handle the massive data throughput required for large hospitals and reference labs. We process thousands of claims daily without sacrificing accuracy or attention to detail.
Specialized Lab Expertise
We understand the nuances of laboratory billing, including molecular diagnostics, pathology, and toxicology. We ensure that your technical and professional components are billed correctly every time.
Questions About Lab & Hospital Billing Services
Professional billing (CMS-1500) covers the services of individual physicians, while Institutional billing (UB-04) covers the services provided by facilities like hospitals, skilled nursing facilities, and laboratories.
CLIA certification is required for laboratories to receive Medicare and Medicaid payments. Billing must include the laboratory’s specific CLIA number to verify that the facility is authorized to perform the tests being billed.
An internal audit is conducted by your own staff or consultants to monitor quality, while an external audit is often performed by insurance payers or government agencies to verify compliance and payment accuracy.
The CDM, or "chargemaster," is a comprehensive list of all billable items and services provided by a hospital. Maintaining an accurate and up-to-date CDM is crucial for ensuring that every service provided is captured and billed correctly.
Many lab denials occur because the payer deems the test "not medically necessary." We proactively manage this by ensuring the correct diagnosis codes (ICD-10) are linked to the laboratory codes (CPT) at the time of submission.