Molecular & Genetic Testing Billing
Panel coding, unbundling compliance, and payer-specific molecular policies — handled by specialists.
Our specialty
Laboratory billing that captures every reimbursable dollar.
High-volume molecular, toxicology, pathology, and clinical labs — LIS-aware RCM with LCD/NCD discipline.
Why lab billing is uniquely hard
Volume, complexity, and policy — all at once.
01
High volume, thin margins
Thousands of accessions mean a 2% denial rate becomes a six-figure problem fast.
02
Complex CPT / HCPCS families
Molecular panels, PLA codes, and evolving NGS guidance change faster than most billing teams can track.
03
Medical necessity / LCD-NCD rules
Payers demand precise ICD linkage — generic coding collapses under lab scrutiny.
04
Panel unbundling compliance
Incorrect unbundling invites audits; over-bundling leaves reimbursable dollars behind.
05
Payer-specific lab policies
Every major payer maintains lab carve-outs, frequency limits, and unique edit logic.
Capabilities
Built for the menu you actually run.
Toxicology & Pain Management Labs
Defensible UDT billing with medical necessity linkage and frequency edits.
Pathology
Professional and technical pathology billing with clean accession-to-claim traceability.
Clinical / Reference Lab Billing
High-volume clinical testing with CLFS awareness and client-bill vs. insurance routing.
LIS Integration & Automation
HL7/API accession feeds, auto charge creation, and exception queues — no rip-and-replace.
Prior Auth for Genetic Testing
Clinical packets, portal submissions, and auth numbers tied to the claim.
Medical Necessity & ICD-to-CPT Linkage
LCD/NCD checks before submission so medical necessity denials never become the norm.
Medicare CLFS & PAMA Reporting Compliance
Rate awareness and private-payer reporting support so compliance doesn’t become a surprise.
How we work with labs
From accession to remittance.
LIS-aware onboarding
Map accession flows, charge masters, and client-bill vs. insurance paths.
Rule the edits
Deploy lab-specific scrubbing — LCD/NCD, frequency, and molecular policies.
Work denials like specialists
Molecular and toxicology denial playbooks with clinical appeal support.
Prove the lift
Accession-level KPIs, denial mix, and net collections reviewed monthly.
Lab case study
Independent molecular lab — denials cut 48%, net collections ↑27% in 6 months.
Regional NGS & infectious disease lab · 1,200 accessions/day
“MedfirstRCM finally spoke fluent laboratory. Our denial mix dropped and cash stabilized within a quarter.”
Lab FAQ
Straight answers for lab leaders.
Yes. We connect via HL7, API, or secure file exchange so accessions flow into charge capture without disrupting lab ops.
See exactly how much revenue you're leaving behind.
Book a free practice audit. We'll map your denials, aging, and coding gaps — and show you a clear path to lift.