Did you know? Implementing an electronic health record (EHR) can dramatically streamline your internal workflow and facilitate more effective communication with practitioners and patients. Adding the technology alone won’t essentially make your organization as lean as possible. Especially when it comes to dealing with the complex regulations in the healthcare industry that seem to constantly be rolling out another layer then it is better to shift towards innovative laboratory medical billing solutions. While according to a recent survey, it has been revealed that a large percentage of physicians (91%) polled preferred to the least expensive option of outsourcing lab billing services. Outsourcing billing services will reduce potential financial challenges for your business. 

When a practice fails to adequately vet potential revenue generation due to billing challenges, then you can acquire knowledge-base assistance from an expert lab billing company. With a properly secured system, they can manage data flow across a network of multiple channels for accurate results. Moreover, independent or small clinical laboratories who can’t afford expensive equipment for billing services can easily outsource their billing cycle to a firm that can streamline your claim submission procedure with compatible technology. 

In addition to this, outsourcing lab billing services is one option that can help you manage the revenue cycle without allocating financial and human resources. If you are still hesitant to relinquish total control over your billing cycle, then the following seven financial benefits of outsourcing lab billing services can help you make a better decision.


By partnering with a trusted lab billing company, you’ll need to invest fewer dollars and man-hours. Moreover, billing companies always stay consistently compliant with up-to-date coding changes, modifiers, and subsets.

Hence, you don’t need to allocate your lab staff to spend time keying in information and preparing claims for submission. We all have heard horror stories about a lab staff being on the phone call for one or two hours in order to get pre-authorization from insurance carriers. That comes up with the time “wasted” that could be spent educating patients about their conditions or responding to patient portal inquiries. In this way, they are also compromising a potential revenue that can be earned from a huge customer-base.


Laboratory billing services utilize two primary codes that are set forth for such purposes.

  • International Statistical Classification of Diseases and Related Health Problems and more commonly as the International Classification of Diseases, or ICD.
  • Current Procedural Technology Code Set and informally as the CPT.

Laboratory billing utilizes two primary sets of codes set forth for such purposes. The first is known formally as the International Statistical Classification of Diseases and Related Health Problems and more commonly as the International Classification of Diseases or ICD. The ICD is maintained by the World Health Organization (WHO) and is accepted as the international diagnostic and epidemiological standard. It provides a framework of diagnostic codes that classify diseases, symptoms, injuries, and other complaints.

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The second code set, known formally as the Current Procedural Technology Code Set and informally as the CPT, is provided by the American Medical Association and identifies services rendered rather than a diagnosis. The CPT delineates all the various medical, surgical, and diagnostic services performed by US practitioners. It is designed to provide a set of uniform classifications for use by medical providers, patients, coders, insurance companies, and other payers. Lab medical billing professionals are qualified and stay compliant with the updates in medical codes. Hence, they can help you earn potential revenue even in the ever-evolving medical coding environment.


Once codes are determined, the lab collections and revenue cycle management phase begins. In most cases, the lab bills the insurance company or other payer directly or via a clearinghouse, use an ANSI 837 claim file submitted electronically on an electronic data interchange (EDI). Once received, the payer utilizes medical claims adjusters or even advice from medical practitioners to evaluate medical necessity, patient eligibility, and whether the provider holds the necessary credentials to perform the procedure.

Finally, if a claim is approved, the payer reimburses the provider at a pre-negotiated rate for a percentage of the billed services. Denied or failed claims are sent back to the provider as an explanation of benefits (EOB), who must then make corrections and resubmit the claim. In many cases, this process occurs multiple times until the payer makes the agreed payment or the provider accepts a partial payment.


While the information associated with your lab billing services is essential to identify key areas that can stimulate future growth. You can’t leverage your business growth without the knowledge of basic lab economics. On the simplest level of analytics, you should keep the track record of overall patient volume to determine daily and monthly patient activity across all the locations. Moreover, you can also estimate the gross charges and determine accurate CPT codes that are suitable for each interacting visit of a patient.

On a broader level, you can also estimate the expected gross billing per month and compare it to the actual charges of services that you have furnished to each patient. This key performance indicator (KPI) will help you decide whether your average charge level is consistent with your expectation _or more specifically, your laboratory medical billing services are complying with your workflow. It would also help you generate accurate revenue reports that will give you an insight into net revenue generated by your lab business. Hence, it would provide a clear picture of how you can operate your lab operations efficiently.

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However, lab billing services require an in-depth knowledge of key areas that can incorporate to maximize the gross revenue. Besides, you can focus on the percentage of your cash that you have to collect in return for the services delivered to each patient. Perhaps, more accurately you can collect the right amount as the accrual rate for each payer. Then compare these accrual rates and estimate your relationship with each payer, with the cost of each different CPT code procedure. Together with other costs including; overhead and accession, an analytical view of your lab billing services would help you determine the profitability of each procedure, payer relationship, and client contract; use similar projections to gauge the profitability of opportunities coming forward.

Unfortunately, dysfunctional lab billing procedures can cause the opposite effect within your lab. If lab billing and coding procedures are not properly used then increasing claim denials can aggregate account receivables.  Generally, if your AR is sitting at 40 to 50 days then your billing department is functioning at an average rate. However, if AR time is consistently increasing than the 60 days limit and over then you are risking your business a revenue loss. It can lead to hampering your efforts to continue providing services or purchase new equipment.


Lab owners and their billing practitioners should learn the above-mentioned services to better represent your laboratory’s daily, weekly, and monthly activities. Labs should implement modern software systems to provide electronic health or laboratory records and streamline information flow. Lab owners should allocate proper capital investment to implement this system for lab billing services. If it is expensive then they should outsource laboratory medical billing services. A laboratory billing company will just charge a fixed subscription percentage and stimulate your operational capabilities in a cost-effective way.

Simply, installing a software system program inside your lab isn’t enough. You’ll need to dedicate time to properly analyze the data captured by your billing system and develop the skills necessary to gather useful information from it. Primarily, it is essential to identify strengths, areas of need, and opportunities of growth.

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For many labs, outsourcing lab billing services can be a way to achieve the essential deep analysis while preserving financial, physical, and personnel resources for other essential activities. Therefore, partnering with a laboratory billing is a thorough approach to streamline your operations.


It is essential to drive improved cash flow and reduced operating costs. Maintaining a streamlined lab billing department of your own involves the associated software fees, initial and ongoing training costs, and salaries of skilled employees. As the healthcare system of the United States, overhead costs balloon to approximately $190 billion USD. Thus, it is a great way to reduce expenditures and promote your healthy cash flow outsourcing your lab billing service to overhead your excessive operational costs.


If you want to ensure the success of your business then strive to eliminate billing and coding errors. To assist with this, professional healthcare coding audits and compliance services can provide data-driven solutions to ensure your coding is accurate, compliant, and up-to-date resulting in higher settlements. According to a recent study. 50% of Medicare Claims reflect some type of medical billing errors. Moreover, state of the art billing software further decreases your chance of encountering the billing and coding errors that can delay payments and increase your workflow and billed hours. Most importantly, accurate billing and coding can cause a significant improvement in data for your analysis.


Your lab deserves every effort possible to improve efficiencies, increase revenue, and reduce opportunities for growth. However, many lab managers simply don’t have the time, staff, or resources necessary to dedicate an adequate focus to the nuances of lab billing services. Therefore, hiring a customized service and solution can help you manage your lab. So it is a real opportunity for improved lab performance.

Finding the right laboratory billing company is important to ensure your management success. You can find hundreds of laboratory medical billing companies with a simple internet search. However, to discern the best among them is a crucial component to stimulate your cash flow opportunities. To that end, a qualified medical billing company is your premium choice for lab billing companies in the United States who can stand ahead in providing satisfactory medical billing services to encounter arising financial challenges for the clinical laboratories.