Pathology Billing Services

By how they were separately identified and submitted, taken from the gross description. Several specimens received in individually labelled containers are generally separate examinations, each with its own value. Groups that bill one examination per case, regardless of how many specimens arrived, undercount consistently. The gross description already contains the answer if it is read carefully.

Probably not all of them. Special stains and immunohistochemistry are billable alongside the examination, often counted per antibody applied, and they are easy to miss because attention sits on the diagnosis. Reconciling the daily stain log against submitted charges is a short task that consistently recovers meaningful revenue in most pathology practices.

They can, when the extra technical work is documented. Cutting further levels on a block to reach a diagnosis represents genuine additional effort, but a report that only records the final diagnosis gives no evidence it happened. Noting levels and recuts as they are performed makes that work visible and defensible on the claim.

When another entity owns the laboratory and employs the technical staff. In that arrangement the laboratory bills the technical component and your group bills the professional interpretation. Billing globally collides with their claim on every case from that site. We configure the rule per laboratory during onboarding so it is never judged case by case.

Yes, consultation on referred material is a distinct and billable service. It is frequently performed as a professional courtesy and never charged for, particularly within academic or hospital networks. Logging referred-in cases separately from your own specimens makes the consultation visible to billing, which turns unpaid expert review into legitimate revenue.

They cannot be billed. An unsigned case is an incomplete service, so it sits in the system accumulating quietly until the filing deadline passes and the value is lost entirely. We report unsigned cases by pathologist each week, which converts an invisible backlog into a short and manageable task for the group.

It uses its own code families and often distinguishes between screening and interpretation, with different rules depending on whether a cytotechnologist or pathologist performed the review. Screening programmes also carry frequency considerations. Groups performing both types of work need the two tracks configured separately rather than treating all specimens the same way.

With more front-end verification than routine histology. Molecular and genetic studies are high value, often require prior authorisation, and carry coverage criteria referencing specific clinical circumstances. Running one without confirming coverage risks a substantial unrecoverable loss. We screen these separately so they are never performed on an assumption about coverage.

Yes, for each combination of pathologist, facility, and payer that you bill. Groups covering several hospitals frequently have gaps, and a missing enrollment produces non-participating denials across every case read from that site. Because pathology volume is so high, the losses accumulate rapidly. We track enrollment and effective dates per site as standard.

Counting specimens properly from the gross description. Most groups bill fewer examinations than were genuinely submitted, and the shortfall repeats on every multi-specimen case. Comparing a week of gross descriptions against billed units usually reveals it immediately. The correction is a coding process change, so the improvement appears in the next cycle.