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Overview of Clinical Lab Billing Service

Running a clinical lab while managing the medical billing process on your own is not an easy feat. Clinical and reference labs encounter multiple challenges while managing their billing and payment cycles.

Clinical lab billing is a complex process that requires interactions between the lab, pathology group, and the payer. After running the prescribed tests, the lab must assign diagnostic and procedure codes to indicate which services were performed. They must handle claim submission and oversee the collection process, including follow-ups for timely payments.

MediBill MD offers professional clinical lab billing services to help you stay on top of your competition:

  • Pre-test eligibility verification
  • Claim creation and submission via clearinghouse
  • Claim follow-up, rework, and resubmission
  • Real-Time claim tracking
  • Denial management
  • Patient-friendly statements
  • Automated EOB reconciliations

Challenges Faced in Clinical Lab Billing Solutions

As a clinical lab, you must realize the importance of efficient payment processes and invoicing. But are you still struggling to optimize your clinical lab billing processes? The common challenges dragging your lab down can be one or all of the following:

High Claim Denial Rate

Clinical labs face a challenge with claim denials, which is made even worse by the varying communication requirements of different payers.

Lack of Patient Awareness

Medical billing can be confusing for patients, who may not know if they need a referral or why their coverage has changed. This makes it challenging for labs to keep patients informed about their billing.

Inaccurate Coding

It is one of the most prevalent issues in medical billing processes. Incorrect or over-coding not only results in claim denial but also leads to heavy penalties and compromises your practice's reputation.

Inaccurate or Incomplete Patient Data

It is the most common reason for a payer to reject a claim. The reasons for such claim denials and rejections vary from missing required fields to spelling errors.

Multiple Claims Filing

Most laboratories find it unpleasant to file repeated claims, especially if they offer specialty healthcare testing services. Since no tools are available for generating multiple claims at once, they might end up submitting each claim separately. As a result, the staff feels exhausted and more involved in doing the documentation.

Inadequate Supporting Documentation

Insurance companies require supporting documentation to settle claims by laboratories. They will not think twice before denying a claim if you fail to submit the required details.

Payment-Associated Issues

Billing challenges extend beyond denials. Clinical laboratories must also navigate other payment-related issues, including denied pre-authorization, delayed payments, and pricing disputes.

Outsource Clinical Lab Billing Services

Healthcare labs often face challenges in managing their revenue cycle and complying with billing regulations, which can be costly and overwhelming.

However, when you outsource your clinical lab billing to MediBill MD, you get access to certified coders and billing specialists who are well-versed and experienced in providing clinical medical billing services. Some other benefits are listed below:

  • Increased lab cash flow with streamlined operational processes.
  • Reduced billing and coding errors.
  • A dedicated team of certified coders and clinical lab billing specialists who are constantly upgrading their skills and knowledge with ever-evolving regulations.
  • A team of clinical lab billing professionals will process claims faster than your in-house billing team who are often tasked with other responsibilities.
  • Enjoy automated benefit and insurance eligibility verification.
  • Efficient denial management and resolution.
Streamlined Procedure


Outsourcing clinical lab billing services may seem expensive, but in reality, it is cost-effective. By outsourcing, you will not have to spend money on hiring and training in-house staff, buying expensive billing software, or keeping up with the latest regulations and compliance requirements. Besides, outsourcing can help you avoid costly billing errors and denials that can seriously impact your revenue and reputation.

When you outsource your clinical lab billing to experts, you sign up for many benefits, including cost-saving (as you don't have to hire in-house staff), access to certified coders and billing experts, reduced billing and coding errors, and better patient satisfaction.

If you want to boost your reimbursements, enhance patient satisfaction, decrease account A/R days, and reduce your lab's operating cost, then outsourcing is worth the investment. You can increase your practice’s efficiency and revenue by outsourcing your clinical lab billing to professionals.