Running a pathology lab is hard enough without chasing down underpayments, resubmitting claims, or playing phone tag with payers. Yet many U.S. labs are losing thousands each month because of outdated beliefs about pathology billing and coding services.
Let’s bust some of the most common myths we hear from labs and show you how modern, tech-enabled pathology revenue cycle management (RCM) can turn your billing into a profit driver – not a headache.
Myth #1: “Our LIS Handles Billing Well Enough.”
Reality: Your LIS (Laboratory Information System) is built for lab operations – not pathology revenue cycle management.
An LIS is excellent at accessioning, result reporting, and QC tracking. But it doesn’t handle payer-specific rules, denial management, or payment posting efficiently.
Fix: Integrate your LIS with a dedicated pathology billing services platform like RevGen-i.
With seamless LIS integration, RevGen-i automatically pulls charges, runs medical necessity edits, and submits clean claims – so your team can focus on testing, not chasing claims.
Myth #2: “Pathology Coding Is Simple — It’s Just 88300–88309.”
Reality: Pathology coding spans AP, CP, molecular pathology, and add-on codes like special stains, IHC, and FISH. Missing just one CPT code or modifier (26/TC) can mean lost revenue – and many labs don’t catch it until it’s too late.
Fix: Partner with a pathology coding services team that combines certified coders with AI-powered workflows to capture every CPT code accurately, apply modifiers correctly to avoid denials and validate documentation support medical necessity before claims go out.
Myth #3: “Denials Are Just Part Of Doing Business”
Reality: Most pathology claim denials are preventable.
The top denial reasons for pathology billing – missing ICD-10 codes, wrong modifiers (26/TC), medical necessity failures – are fixable with the right front-end process. Every preventable denial you ignore is essentially free money left with the payer.
Fix: 3Gen’s pathology RCM solutions use coding audits and run real-time eligibility verification before testing. Labs that automate front-end checks cut eligibility-related denials by up to 30%.
Myth #4: “We’ll Catch Underpayments Eventually”
Reality: Without robust analytics, underpayments slip through the cracks.
Pathology groups lose revenue when they don’t reconcile every CPT and line item against payer contracts. Many underpayments never get appealed simply because no one is tracking them.
Fix: Use a real-time RCM dashboard to monitor clean claim rates, AR days, denial categories, and reimbursement trends by payer. Labs that actively track KPIs see up to 20-30% faster collections.
Myth #5: “Coding Audits Are Only About Compliance”
Reality: Coding audits protect revenue, not just compliance.
Yes, CMS and commercial payers expect compliance, but audits also uncover missed units, unbilled add-on codes, and downcoded pathology cases that directly affect your bottom line.
Fix: Perform quarterly coding audits – both retrospective and pre-bill – to catch revenue opportunities early. Our coding team regularly recovers 3-7% of missed revenue for pathology clients through targeted audits.
Myth #6: “Automation Will Replace Our Billing Team”
Reality: Automation makes your team more effective – it doesn’t replace them.
Manual status checks, data entry, and claim follow-ups waste valuable staff hours. The best labs use automation to handle repetitive tasks so billing teams can focus on high-value problem solving.
Fix: Automate claim status checks, payment posting, and denial routing. With RevGen-i, labs see a measurable drop in AR days – without adding headcount.
The Bottom Line: Pathology Billing Doesn’t Have to Be This Hard
Labs that treat billing as an afterthought end up with high write-offs, burned-out staff, and unpredictable cash flow.
At 3Gen Consulting, we help labs take control of their pathology revenue cycle with:
- Specialized pathology billing and coding services (AP + CP)
- RevGen-i, an AI-powered RCM platform that integrates with your LIS
- Real-time eligibility verification and medical necessity checks
- Analytics dashboards that track clean claim rates, denials, AR days, and collections
Stop leaving money on the table. Schedule a free pathology RCM assessment today and see how much revenue you could recover.
