SPECIALIZED LABORATORY BILLING & REVENUE CYCLE SERVICES

Simplify Complex Laboratory Billing and Strengthen Your Revenue Cycle.

Laboratory billing involves unique coding requirements, payer policies, medical necessity considerations, ordering provider information, claim edits, and reimbursement challenges. Managing these requirements efficiently requires a structured approach and a clear understanding of laboratory revenue cycle workflows.

Maverick provides laboratory billing and revenue cycle support designed to help clinical, diagnostic, and specialty laboratories manage claims, reimbursement, denials, accounts receivable, and billing operations with greater visibility and control.

Talk to a Laboratory Billing Specialist
Request a Billing Assessment
INTRODUCTION

Laboratory Revenue Cycles Require Specialized Attention

Laboratory billing differs from traditional physician billing.

Testing services may involve complex coding, medical necessity requirements, payer-specific rules, ordering provider information, specimen-related documentation, and coverage policies that can directly affect claim processing and reimbursement.

Maverick provides structured support across the laboratory revenue cycle, helping laboratories manage the administrative and financial processes that take place from test ordering through claim resolution and payment.

Our goal is to help laboratories reduce unnecessary billing complexity, improve workflow visibility, and create a more organized approach to reimbursement management.

OUR LABORATORY BILLING SERVICES

Comprehensive Support Across the Laboratory Revenue Cycle

Laboratory Charge Capture

Support for organizing and preparing billable laboratory services for the billing process.

Laboratory Coding

Support for applicable CPT, HCPCS, ICD-10, and modifier requirements based on available documentation and billing requirements.

Medical Necessity Review Support

Review available information against applicable payer requirements to help identify potential billing issues before claim submission.

Claim Creation and Submission

Preparation and electronic submission of laboratory claims through established billing workflows.

Claim Scrubbing

Review claims for missing information, potential errors, and issues that may affect payer processing.

Denial Management

Monitor outstanding laboratory claims and prioritize follow-up based on aging, claim status, payer response, and recovery opportunity.

Accounts Receivable Management

Monitor outstanding laboratory claims and prioritize follow-up based on aging, claim status, payer response, and recovery opportunity.

Payment Posting

Accurate posting and reconciliation of insurance and patient payments.

Underpayment Review

Review payment activity to identify potential discrepancies requiring further investigation.

Payer Follow-Up

Follow established workflows for pending, delayed, and unresolved claims.
LABORATORY CODING & BILLING COMPLEXITY

Managing the Details Behind Every Claim

Laboratory claims may involve several variables that need to work together accurately.
A structured billing process helps laboratories manage these requirements more consistently and identify issues that may affect claim processing.
Depending on the type of laboratory and
services provided, billing workflows may involve:
  • CPT Coding
  • HCPCS Coding
  • ICD-10 Diagnosis Coding
  • Modifier Requirements
  • Medical Necessity Requirements
  • National Coverage Requirements
  • Local Coverage Requirements
  • Payer-Specific Billing Policies
  • Ordering Provider Information
  • Referring Provider Requirements
  • Panel and Component Billing Considerations
  • Units of Service
  • Claim Edits
  • Documentation Requirements
DENIAL MANAGEMENT FOR LABORATORIES

Identify the Reason. Resolve the Issue. Improve the Process.

Laboratory claims can be denied for a variety of reasons, including coding issues, medical necessity requirements, missing information, payer policy limitations, eligibility concerns, or claim submission errors.
Maverick helps laboratories manage denials through a structured workflow.
1
Analyze the Denial
Review the payer response and available claim information to understand the reason for the denial.
2
Identify the Required Action
Determine whether the claim requires correction, additional information, appeal, resubmission, or another follow-up step.
3
Manage Resolution
Follow the appropriate workflow to address the issue and move the claim toward resolution.
4
Track Recurring Trends
Monitor recurring denial patterns to identify potential process improvements.
LABORATORY ACCOUNTS RECEIVABLE MANAGEMENT

Keep Outstanding Claims From Becoming Lost Revenue

Outstanding laboratory claims can become increasingly difficult to resolve as they age.
Maverick provides accounts receivable support designed to help laboratories maintain visibility into outstanding claims and prioritize follow-up activity.

Claim Aging Review

Organize outstanding balances by aging and identify claims requiring attention.

Payer Follow-Up

Contact or follow up through the appropriate payer process regarding pending or unresolved claims.

Claim Status Review

Monitor claim status and determine the next action required.

High-Value Claim Prioritization

Prioritize claims based on value, aging, payer status, and recovery opportunity.

Escalation Support

Follow established escalation processes for claims requiring additional attention.

Resolution Tracking

Maintain visibility into actions taken and the current status of outstanding claims.
7. OUR LABORATORY BILLING PROCESS

A Structured Workflow From Service to Reimbursement

1

Information and Charge Review

Available patient, ordering provider, diagnostic, and service information is reviewed and prepared for the billing workflow.
3

Claim Preparation

Claims are prepared with the information required for submission.
5

Claim Submission

Claims are submitted electronically through the appropriate billing workflow.
5

Payment Posting

Payments and adjustments are posted and reconciled.
5

Reporting and Optimization

Billing trends and available performance data are reviewed to identify opportunities for process improvement.
2

Coding Support

Applicable coding and billing requirements are addressed based on the available information and service provided.
4

Claim Review

Potential errors, missing information, and payer-related issues are reviewed before submission.
5

Claim Monitoring

Payer responses, claim status, and outstanding claims are monitored.
5

Denial and A/R Follow-Up

Denied, unpaid, and outstanding claims are managed through established follow-up processes.
LABORATORIES WE SUPPORT

Revenue Cycle Support for Different Laboratory Models

Maverick provides support that can be adapted to the operational requirements of different laboratory organizations.
1
Clinical Laboratories
Support for laboratories providing routine and specialized clinical testing services.
2
Diagnostic Laboratories
Billing support for organizations offering diagnostic testing and related laboratory services.
3
Specialty Laboratories
Revenue cycle workflows adapted to laboratories with specialized testing and service requirements.
4
Reference Laboratories
Support for complex billing processes involving testing relationships and ordering providers.
5
Molecular Laboratories
Billing support adapted to the requirements of molecular and advanced diagnostic testing.
6
Toxicology Laboratories
Revenue cycle support for laboratories managing toxicology testing and related billing requirements.
WHY MAVERICK

Specialized Support for Complex Laboratory Revenue Cycles

Laboratory billing requires attention to detail and an understanding of how coding, payer policies, documentation, and claim processing affect reimbursement.
Maverick provides:
1
Structured Billing Workflows
Organized processes designed around laboratory billing requirements.
2
Experienced Revenue Cycle Support
Professional support across claims, denials, A/R, payment posting, and payer follow-up.
3
Greater Visibility
Clearer insight into billing activity, outstanding claims, and areas requiring attention.
4
Proactive Follow-Up
Established workflows for monitoring unresolved and aging claims.
5
Adaptable Support
Services structured around your laboratory model, testing services, payer mix, and operational requirements.
GET STARTED TODAY

Strengthen Your Laboratory Revenue Cycle

Managing laboratory billing requires a coordinated approach to claims, coding, payer requirements, denials, and accounts receivable.

Maverick helps laboratory organizations create more organized billing workflows, maintain greater visibility into reimbursement activity, and address the challenges affecting their revenue cycle.

Talk to a Laboratory Billing Specialist
Request a Billing Assessment

Let's find where your revenue cycle can perform better.