PAMA-compliant billing at diagnostic volume
Laboratory & Diagnostics Billing at Enterprise Volume
PAMA rates, LCD compliance, and ABN management for independent labs and diagnostic networks running high-volume testing.
Lab billing runs on a fundamentally different regulatory framework — PAMA fee schedules, Local Coverage Determinations, and CLIA compliance — and at diagnostic network volume, the margin for error shrinks fast. We bring lab-specific billing expertise built for networks processing high test volume across multiple reference and reflex testing relationships.
Common Challenges
Where labs & diagnostics networks lose revenue
LCD compliance at volume requires systematic diagnosis matching
Medicare's Local Coverage Determinations define which diagnoses justify each test. At high volume, manually verifying LCD compliance on every requisition isn't feasible — it requires systematic, automated-assisted checking.
ABN issuance workflows must scale without becoming blanket waivers
Networks need ABN workflows that trigger correctly at volume — issued before testing, tied to actual LCD non-compliance — without defaulting to blanket ABNs that create compliance exposure.
Molecular and toxicology billing carries elevated audit risk at scale
High-volume molecular diagnostic and toxicology billing draws disproportionate payer scrutiny. Networks need documentation and coding discipline that holds up under audit, consistently, across every test run.
What's Included
Labs & Diagnostics.
Done right, at scale.
Specialty-specific coding expertise backed by a dedicated implementation team and full transparency through your client portal.
Talk to Our TeamReady to get started?
Free revenue cycle assessment — we'll show you exactly where the gaps are and what it would take to fix them.
Get a Free Assessment