Clinical, molecular, pathology, and toxicology billing done by coders who know CPT 80000 to 89999, the LCDs, and payer-specific medical necessity rules. Twelve years, twenty-plus states, and appeal rates that keep a lab profitable.
Most billing companies handle the easy sixty percent. These are the four zones where labs quietly bleed revenue.
The problem. Missing ICD-10 diagnoses on requisitions. Ordering physicians skip medical necessity documentation. Claim denied CO-11 or CO-50.
Our fix. Pre-submission requisition review and an auto-query workflow back to the ordering physician for missing ICD-10s. Fixed before the claim leaves.
The problem. Claims batch-submitted end of week. Timely filing deadlines missed on delayed results. UHC and Medicare require 90 days, and labs regularly miss it.
Our fix. An LIS webhook triggers coding and submission the same hour. Every claim goes out within four hours of result finalisation.
The problem. Molecular and genetic tests denied on LCD medical necessity. Novitas L37822, Palmetto L38986, and 47 other active LCDs change quarterly.
Our fix. Live LCD tracking across 12 MAC regions. A pre-submission compliance check flags mismatched ICD-10s before the claim goes out.
The problem. Denials sit in a queue. Thirty to ninety day appeal windows expire. The previous biller writes them off as uncollectable and the money vanishes.
Our fix. Same-day denial working. Peer-to-peer requests filed within 24 hours. Every appeal tracked to close-out, at a 78 percent average win rate on medical necessity.
Total average leakage: $47,000 to $120,000 a month for a mid-size molecular lab. Most of it recoverable.
Reimbursement rates look fine on paper. Then denials happen. This is what independent labs collect per test, and how much they leave behind.
| Test category | Average allowed | Denial rate | Net collected | Lost per test |
|---|---|---|---|---|
| Basic Metabolic Panel 80048 | $11.60 | 10% | $10.44 | $1.16 |
| Comprehensive Metabolic Panel 80053 | $14.49 | 12% | $12.75 | $1.74 |
| Vitamin D 25-Hydroxy 82306 | $34.05 | 28% | $24.52 | $9.53 |
| Lipid Panel 80061 | $13.39 | 14% | $11.52 | $1.87 |
| Molecular Pathology 81479 | $2,180 | 47% | $1,155 | $1,025 |
| Genetic Testing Panel 81443 | $3,500 | 62% | $1,330 | $2,170 |
| Toxicology Confirmation 80307 | $97.75 | 31% | $67.45 | $30.30 |
| Anatomic Pathology 88305 | $65.20 | 22% | $50.86 | $14.34 |
A lab running 500 molecular tests a month is losing roughly $512,500 a year to denials. Most of it recoverable with proper LCD compliance, prior authorisation workflows, and appeals that actually get filed.
Local Coverage Determinations change every quarter. Novitas, Palmetto, WPS and the rest each maintain hundreds. Miss one update and a denial rate spikes overnight.
Five stages, and what our team is doing while your claim moves through them.
The moment a visit closes in your practice management system, we pull the encounter, patient demographics, and insurance details. No batch waiting, no end of day exports. Works with Athena, eCW, Kareo, DrChrono, and most major PM platforms.
Averaged across our active client base. Individual results vary by specialty, payer mix, and whatever the billing setup was before.
“We had eighteen months of aged AR our prior biller had quietly written off. CureMed pulled the report, worked the claims, and recovered just under $290K in the first quarter. We did not even know it was there to find.”
Coders who work your specialty daily, not generalists reading a manual. Same rate whichever one you are.
You send us test requisitions and results from your LIS, through a direct integration or a secure upload. We assign CPT 80000 to 89999 codes and ICD-10 diagnoses, scrub against LCDs and payer edits, submit electronically, post payments and ERAs, and handle prior authorisations, denials, and appeals. You keep visibility into every step through your dashboard.
A flat 3.99 percent of collections. That is the whole fee: no setup cost, no monthly platform charge, no per-claim add-ons. The same rate applies whether you are a single-site clinical lab or a multi-location reference lab. If we do not collect, you do not pay us.
Most labs are fully live within two to three weeks. We start with a free audit, then map the transition around your existing LIS and your staff's workflows. Nothing goes live until you have signed off on every step, and we run in parallel during handover so no claims fall through the gap.
Yes, and it is the part most billers get wrong. Molecular and genetic panels carry the highest denial rates of anything a lab bills, almost entirely on LCD medical necessity. We track Local Coverage Determinations across all twelve MAC regions and check every claim against the current criteria before it goes out.
We work it. Aged lab AR is often recoverable well past the point a previous biller gave up, particularly denials that were never appealed and claims that were paid but never posted. We audit what you have before quoting anything.
Send us an aging report and a month of denials. We will tell you what is recoverable, what is not, and what we would go after first. No obligation to hire us.