Pathology Billing Services
NextGen Billing Solution delivers specialized pathology medical billing services supported by expert CPT coding, CLIA compliance, and proactive denial management. With certified billing professionals managing anatomic and clinical pathology claims, A/R follow-up, and full revenue cycle operations, this solution ensures accurate reimbursement, streamlined workflows, and improved financial performance for pathology practices.
Advantages of Our Innovative Pathology Medical Billing Services
CPT and ICD-10 Coding Expertise
NextGen Billing Solution specializes in pathology billing, handling CPT codes for anatomic (88000–88399) and clinical pathology (80047–85999) with expertise in surgical pathology, immunohistochemistry, molecular diagnostics, and cytopathology. Accurate ICD-10 coding and proper use of modifiers (-26, -TC, -90, -91) help prevent claim denials and protect your revenue.
MIPS Specialists
NextGen Billing Solution helps pathology labs optimize Medicare payments by managing the complex MIPS reporting process. MIPS determines Medicare reimbursement through four performance categories: Quality (30%), Cost, Improvement Activities (15% for large practices, 50% for small practices), and Promoting Interoperability (25%). Pathology labs must report six quality measures and complete Improvement Activities attestations to avoid penalties and maximize incentives.
Our team of MIPS specialists focuses on pathology-specific quality measures, including Barrett’s esophagus documentation, completeness of prostatectomy reports (pT, pN, Gleason score, margins), and MMR testing recommendations. We handle data collection, measure selection, and timely CMS submission, ensuring your Medicare reimbursement is protected from payment adjustments.
CLIA Compliance and RCM Management
NextGen Billing Solution streamlines your lab’s revenue cycle with CLIA compliance, accurate documentation, and efficient front- and back-office processes. It ensures claims include proper credentials, prevents CO-16 and other denials, manages CO-4, CO-97, and CO-167 issues, verifies eligibility, captures LIS charges correctly, and supports systematic A/R follow-up for maximum revenue.
Your Revenue, Our Priority. Partner with a Leading Pathology Billing Company!
Expert pathology billing with CPT coding, CLIA compliance, and A/R management. Streamline your revenue cycle and boost growth by up to 30%.
Unique Billing Challenges Pathology Practices Face
Pathology billing is one of the most complex areas in healthcare, requiring precise handling of dual coding for anatomic pathology (88000–88399) and clinical pathology (80047–85999), as well as managing technical versus professional component splits. Each case may involve multiple specimens, different CPT complexity levels (88300–88309), and accurate ICD-10 codes to establish medical necessity.
Common issues include missing modifiers (-26, -TC) that cause immediate denials, omitted CLIA certification numbers triggering CO-16 rejections, bundling errors leading to CO-97 denials, and medical necessity failures (CO-167). Molecular diagnostics require prior authorization, narrow provider networks create out-of-network challenges, and keeping up with annual CPT updates, payer LCDs, MIPS reporting, and HIPAA compliance can overwhelm internal teams.
How NextGen Billing Solution Supports Pathology Practices
NextGen Billing Solution addresses key challenges for pathology practices, helping reduce claim denials by up to 30% (e.g., from 22% to 5%) and increasing cash flow by 35% through systematic A/R follow-up, accurate modifier application on every claim, and real-time insurance verification. Labs with LIS-integrated billing have also seen a 20% improvement in charge capture and a 15% reduction in lost revenue.
Our certified coders (CPC, CCS) expertly manage all pathology coding complexities, including surgical pathology levels, immunohistochemistry per-antibody billing, molecular diagnostics with gene-specific codes, and cytopathology. Denial codes (CO-4, CO-16, CO-97, CO-167) are handled through structured appeals, while CLIA/HIPAA compliance is strictly maintained. NextGen Billing Solution also optimizes MIPS reporting, reduces Days in A/R from 42 to 25–30 days, and achieves 95%+ clean claim rates.
Process Clean Claims and Reimburse Faster
NextGen Billing Solution for pathology ensures over 95% clean claim rates with multi-level claim scrubbing, precise CPT/ICD-10 coding, and correct modifier application. By reducing average days in A/R from 42 to 25–30 days, we accelerate cash flow and prevent revenue delays. Every claim is submitted accurately the first time, including complete CLIA certification and medical necessity documentation. With NextGen Billing Solution, enjoy faster reimbursement cycles through proactive A/R follow-up and structured denial management. Common denials like CO-4, CO-16, CO-97, and CO-167 are addressed immediately with expert appeals and supporting documentation. Real-time insurance verification minimizes front-end denials, ensuring smoother claim processing.
Keep Your Lab Profitable and Fully Compliant
NextGen Billing Solution offers complete pathology billing services, ensuring full CLIA, HIPAA, and MIPS compliance while optimizing revenue. Our certified billing specialists (CPC, CCS) have advanced knowledge in anatomic and clinical pathology coding, helping prevent compliance issues before they arise. We proactively address regulatory challenges to safeguard your lab from audits and penalties. We manage thorough claims follow-up, recover revenue from aging accounts receivable, and submit accurate, timely claims to maintain steady cash flow. Integrated with your LIS, our technology automates charge capture, minimizes errors, and ensures every billable service is recorded.
Increase your practice revenue by up to 35% with NextGen Billing Solution