- 4009 Hackney Springs Ln, Sachse, TX 75048
Panel Miscoding
LCD Non-Compliance
Missed Reflex Testing Revenue
Frequency Limitation Violations
Wrong Methodology-Based CPT Codes
TransLabs’ specialized RCM services are built exclusively for labs, addressing the unique challenges that generalist billers miss. We provide end-to-end revenue cycle solutions designed specifically to turn laboratory complexity into profitability.
Complete payer enrollment, CLIA certification management, and network participation setup across all insurance carriers. TransLabs manages every credentialing detail so that your laboratory gets paid in-network from day one without any administrative delays.
Real-time insurance verification, benefits investigation, and prior auth completed before specimen processing begins. Confirming coverage upfront eliminates preventable denials and protects your lab from unexpected reimbursement failures.
Patient registration, appointment coordination, insurance verification, and customer service excellence managed by experienced laboratory billing professionals. A well-run front office reduces downstream billing errors and creates a better experience.
TransLabs provides expert RCM services to clinical laboratories in all 50 states, delivering the same exceptional results whether you’re a community hospital lab or a large reference facility. We bring specialized lab billing expertise to facilities nationwide, combining remote efficiency with hands-on partnership.
Each of Medicare's 12 Administrative Contractors maintains its own LCD policies specifying which ICD-10 diagnosis codes support coverage for specific clinical lab tests. These policies differ by MAC, change without notice, and apply to thousands of test-diagnosis combinations. TransLabs maintains live LCD databases for every MAC and validates diagnosis code linkage on every Medicare claim before submission; not just the most common tests.
Medicare restricts how often certain tests can be covered for the same beneficiary within a defined period. HbA1c, lipid panels, PSA, TSH, and many other high-volume tests carry specific frequency limits that vary by MAC. TransLabs monitors each patient's claim history and alerts ordering providers before frequency limits are reached; preventing the automatic denials that are impossible to appeal after the fact.
When a Medicare beneficiary requests a test that may not meet medical necessity criteria under the applicable LCD, a valid ABN must be issued before the test is performed. Retroactive ABNs are not valid, and billing without a valid ABN when coverage is uncertain exposes the lab to recoupment liability. TransLabs implements ABN workflows into your front-end registration process so the documentation is always in place.
The CLFS sets Medicare payment rates for all lab tests and updates annually on January 1. TransLabs monitors CLFS changes, updates billing tables immediately at each rate change, and identifies when a payer is paying below CLFS rates, allowing proactive underpayment recovery before claim filing deadlines pass.
Labs meeting the applicable laboratory definition under the Protecting Access to Medicare Act (PAMA) carry mandatory private payer data reporting obligations during designated data collection periods. Non-compliance carries civil monetary penalties. TransLabs tracks your lab's PAMA obligations throughout the year and ensures reporting requirements are met accurately and on time.
The Office of Inspector General publishes an annual Work Plan identifying billing areas under active audit scrutiny. Clinical laboratory billing appears on the OIG Work Plan regularly, with tumor markers, genetic testing, and toxicology receiving particular attention in recent cycles. TransLabs builds compliance protocols specifically around current OIG focus areas to reduce audit exposure before it becomes a problem.
Most billing companies treat physicians, hospitals, and labs the same. They’re not. Lab billing has its own CPT codes, compliance rules, LIS ecosystem, and payer dynamics. TransLabs was built exclusively for lab billing; every coder, account manager, and appeal writer works only in labs.
Schedule a call with our clinical lab billing specialist. We’ll review your panel optimization, reflex testing denials, LCD compliance, and A/R days
Dedicated billing specialist assigned to your lab
Complimentary 12 month claims audit across Medicare, Medicaid, and commercial payers
Uncover your top 3 revenue leaks (denials, underpayments, coding gaps)
Custom strategy tailored to your specialty and LIS/billing software
Live in 24 hours with no contracts and no upfront fees
Pay only a percentage of what we collect for you
Lab billing covers diagnostic testing claims, using CPT codes 80000–89999 instead of E&M codes. Labs bill under the Clinical Laboratory Fee Schedule, not the Physician Fee Schedule, and face MAC-specific LCDs, PAMA reporting, and frequency limits — plus higher claim volume from multiple referring providers.
It decides whether to bill tests as a panel code (e.g., CMP, BMP, lipid panel) or individual components, based on what was performed and payer rules. Errors trigger MUE denials or compliance violations. TransLabs automates this logic on every claim.
