MedCare MSO’s laboratory billing services encompass all revenue cycle management, coding and claiming diagnostic laboratory test services with appropriate CPT and ICD-10 diagnoses while meeting CLIA, PAMA, and medical necessity requirements, from payer credentialing to old accounts receivable collection from payers. Our laboratory medical billing services offer standalone services that streamline your entire revenue cycle on our all-inclusive platform.
MedCare MSO’s expert laboratory billing services are built to recover every dollar your lab earns. We scrub every claim for coding, modifier and medical-necessity errors before submission within one to two days of the test, then track each one to payment and appeal any denials. The result is more of your earned revenue reaching your account, with 98.5% clean claims on first submission, a 96% collection ratio and up to 35% higher collections.
Labs lose the most revenue to denied claims of any specialty because one small detail can make a low-value claim ineligible for payment. We prevent the most common causes of claims rejections from even being submitted:
Every claim from a laboratory goes through nine different interconnected stages before being finally paid out as revenue. At each of these stages, there is a risk of loss in the revenue cycle due to a lack of laboratory-specific billing expertise. The laboratory revenue cycle management offered by MedCare MSO covers all nine stages, from the initial verification of eligibility to the final analytics dashboards; thus, more of your high-volume, low-dollar claims will be paid on the first attempt, and less money will be stuck waiting to be processed in accounts receivable.
We verify coverage, benefits and medical necessity according to each payer’s LCD/NCD policies specific to your service and verify provider order details to prevent the front-end errors responsible for most lab rejections.
Test orders, demographics and accession charges are captured directly from your Laboratory Information System via HL7/LIS interface. Every billable test is automatic with no manual charge entry
Our certified coders handle the full range of lab coding, CPT (80047–89398), PLA, ICD-10-CM, LOINC and molecular Z-codes with the precision your laboratory billing and coding services depend on to avoid downcoding, rejections and audits.
Prior to submission, each claim is checked against NCCI edits, MUEs and thousands of payer-specific rules by our AI Rule Engine to identify unbundling and modifier errors and achieve a first-pass clean claim rate of up to 98.5%.
Claims are sent electronically to all payers and clearinghouses and are monitored from the moment they leave our system, ensuring nothing goes unclaimed in transit.
ERA and EOB payments are posted to the exact line item and reconciled to your contracted rates. Underpayments are identified and corrected rather than being hidden in the aggregate, ensuring you receive every dollar due.
Denied and misadjudicated claims, including molecular tests marked "investigational", are worked to the root cause and appealed within filing limits. Our denial management team works to recover revenue, instead writing it off.
We ensure that patient responsibility balances are collected with clear statements, flexible payment options and responsive support, closing a revenue cycle loop that many labs overlook.
Real-time dashboards track your clean claim rate, days in A/R, denial trends and net collections, giving your leadership a clear, current picture of lab financial performance at every stage of the cycle.
Our laboratory billing services guarantee accurate claims and a 98.5% First Pass Clean Claims Rate, maximizing reimbursements and reducing denials.
Avoiding billing errors related to coding issues requires competent billing and RCM, which a lab may not always afford. That’s a key reason to outsource laboratory medical billing to an independent partner and one of the advantages of an independent laboratory billing company is that it takes care of updates to coding and all varieties of payers for you. Our medical billing software is compatible with your practice management, EHR, or EMR systems or works independently to ensure all your patient data and revenue management needs are met.
Laboratory medical billing is subject to a number of unique regulations and any oversight can lead to underpayment for services rendered. Our clinical laboratory billing services keep your laboratory claims accurate in accordance with the Clinical Laboratory Improvement Amendments (CLIA) requirements and CMS LCD/NCD guidelines (for services covered under the CLIA waiver). They also assist in dealing with PAMA reporting requirements established by the Protecting Access to Medicare Act of 2014, which affects the Clinical Laboratory Fee Schedule. Our medical coders keep track of all the updates of CPT, HCPCS, ICD-10 codes and guidelines to ensure that your laboratory is always paid in accordance with the most recent policies and regulations.
With MedCare MSO handling your laboratory medical billing services, you can sit back and relax, free from the drudgery of the billing process without sacrificing a dime from your revenue stream. You can rely on the billing reports to provide key performance indicators that help you track the progress of your payments. The most crucial indicators include the speed of the payments and the ratio of your accounts receivable to the value of the services rendered to date. You will observe that payments start coming in faster and outstanding balances begin to dwindle.
Lab billing lifts a huge weight off your shoulders if done right. When you outsource laboratory medical billing to a company that specializes in the work, the team can focus on what matters most delivering high-quality patient care while the experts handle the tedious, detail-heavy tasks submitting clean claims, chasing denials and managing accounts receivable. This is where a strong laboratory billing company earns its place, pairing advanced technology with certified coders to keep claims clean and revenue maximized. The payoff is more predictable cash flow and it’s why 97% of our lab clients stay with us year after year. That’s what you gain partnering with an independent laboratory billing service. You keep doing what you do best and we handle the rest. Your core business is patient care while ours is billing. Together, your patients get the care they need while your lab collects the revenue it deserves.
MedCare MSO has transformed ID Labs’ operations by resolving critical credentialing hurdles and implementing efficient payment systems since April 2024. This partnership successfully restored lost revenue streams and established a more streamlined, productive workflow for the lab.
| Metric | Before | After | Impact |
|---|---|---|---|
| Monthly Collections | $280,000 | $420,000 | 50% Increase |
| Days in A/R | 32 days | 9 days | 72% Reduction |
| Denial Rate (Credentialing) | 28% | 9% | 68% Reduction |
| Provider Networks Active | 4 | 8 | 4 Networks Added |
| Credentialing Time | 20 hours/week | 3 hours/week | 85% Reduction |
| UHC Revenue Recovery |
$0 (Stuck) | $347,050 | 3,685 Claims Resolved |
| EFT Adoption | $0 | 70% | Complete Automation |
| Payment Tracking | Paper Checks (Lost) | Direct Deposit | 100% Visibility |
We will provide you with physician practice management services and modern medical software at a very affordable rate.
We assign a MedCare Regional Manager to your office to ensure that everything runs smoothly.
Get your providers credentialed and enrolled with every payer you need, so no claim is denied for an uncredentialed provider.
At MedCare MSO, our laboratory billing services sit at the center of a connected, AI-powered ecosystem: your clinical documentation, coding and revenue cycle management all under one roof, sharing the same data. That means fewer handoffs, fewer errors and one partner accountable for the whole picture instead of a patchwork of disconnected vendors.
Connects lab results, specimen data and patient records seamlessly, so orders flow into charges without manual re-entry and every billable test is captured.
Captures lab test orders, specimen details and ordering-provider data automatically at the point of entry, ensuring documentation is complete before billing begins.
Assigns accurate pathology and laboratory CPT and ICD-10-CM codes at lab volume with certified-coder oversight to prevent downcoding and denials.
Manages laboratory reimbursements and eligibility, claims, payments, and follow-up, helping reduce duplicate data entry across the workflow.
Leverage MedCare MSO’s lab expertise to improve efficiency and increase revenue.
Business development is crucial for driving growth and client relations in the laboratory services sector.
A member of our team will get back to you within 15 minutes.
For immediate service, give us a call at (800)-640-6409
Labs should consider outsourcing when claim denials, delayed payments, manual charge entry, or payer follow-up start affecting cash flow. MedCare MSO helps labs manage claims, denials, A/R, payment posting, and reporting so the lab team can stay focused on testing operations.
Laboratory billing depends on accurate test orders, medical necessity, diagnosis codes, CLIA details, payer rules, specimen information, and timely claim submission. A small error in any of these areas can delay reimbursement or cause a denial. MedCare MSO helps keep these billing details aligned before claims go out.
Yes, MedCare MSO supports billing workflows for diagnostic labs, toxicology labs, molecular testing labs, clinical labs, and pathology-related lab services. Our team aligns each claim with the test performed, documentation, payer requirements, and reimbursement rules.
Yes, MedCare MSO can support LIS, EHR, and EMR-connected billing workflows where integration is available. This helps reduce manual entry, improve charge capture, and keep test orders, specimen details, and billing information connected.
MedCare MSO helps labs follow billing requirements tied to payer rules, medical necessity, diagnosis support, CLIA-related claim details, and applicable reporting needs. Our team works to reduce billing errors that can create denials, delays, or compliance concerns.
MedCare MSO gives labs a billing partner that understands lab revenue cycles, test-based billing, payer rules, denials, A/R follow-up, and reporting. Our laboratory billing services are built to help labs improve collections, reduce administrative work, and maintain a steadier revenue flow.
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