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Billing Services for Genomic Laboratories

At MedRCM360, we specialize in providing comprehensive Revenue Cycle Management (RCM) solutions tailored for laboratory and genomics-based testing organizations. Our expertise helps precision medicine and genetic testing labs streamline billing operations, reduce denials, and maximize reimbursements while maintaining full compliance with healthcare regulations.

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Specialized Understanding of Genomic Billing

Genomic testing involves complex coding, unique payer policies, and frequent updates to molecular pathology and genetic testing guidelines. Our billing specialists are trained in:

  • Molecular pathology CPT codes (811XX–814XX) and PLA codes
  • Next-Generation Sequencing (NGS) panel billing
  • Tier 1 and Tier 2 molecular testing codes
  • Medicare and commercial payer coverage policies (LCDs/NCDs)
  • Prior authorization and medical necessity documentation

End-to-End Billing Workflow

Our structured workflow ensures complete revenue capture:

Order & Eligibility Verification

Verifying medical necessity, test coverage, and prior authorizations before accessioning.

Accession-Level Charge Entry

Accurate mapping of CPT/ICD-10 combinations based on test performed.

Claim Scrubbing & Submission

Automated validation to ensure clean claims submission to payers.

Payment Posting & Denial Management

Identifying underpayments, addressing CO-16 or CO-50 denials, and initiating appeals.

Patient Billing & Statements

Clear patient communication for self-pay or non-covered genetic testing services.

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Compliance & Documentation Integrity

We adhere strictly to CLIA, HIPAA, and OIG compliance standards. Every claim submission is validated for documentation completeness — including requisition forms, lab reports, and genetic counselor notes where applicable.

Technology Integration

We integrate seamlessly with leading Laboratory Information Management Systems (LIMS) and Electronic Health Records (EHRs) for:

Automated charge capture from accession data

Interface-driven claim creation and reconciliation

Real-time analytics for test-wise revenue and payer trends

Advanced Analytics & Reporting

Our RCM platform provides real-time dashboards and detailed reports on key performance indicators such as denial rates, days in A/R, and payer mix. This data-driven approach enables genomic labs to identify bottlenecks, optimize workflows, and make informed financial decisions.