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Oncology and hematopathology billing carries complexity routine lab billing never touches; molecular/genomic panels, flow cytometry immunophenotyping, FISH probes, and pathologist-interpreted specimens carry unique coding logic and payer scrutiny. Losses compound quietly into six or seven figures missed.
Unregistered DEX Z-Codes
Global vs. Split-Billed Modifier Errors
Tumor Marker Medical Necessity Denials
Flow Cytometry Panel Bundling Errors
Reflex & Companion Diagnostic Capture Gaps
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.
Molecular and genomic tests billed to Medicare Administrative Contractors in a MolDX jurisdiction (Palmetto GBA, Noridian, CGS, and WPS) require a registered DEX Z-Code identifier alongside the CPT or PLA code. TransLabs manages Z-Code registration and technical assessment submissions for your laboratory-developed tests, so claims aren't denied before a medical reviewer ever looks at them.
Each MAC maintains its own LCDs specifying which ICD-10 diagnoses and clinical indications support coverage for specific molecular, cytogenetic, and flow cytometry tests. These policies differ by MAC and change without notice. TransLabs maintains live LCD databases and validates diagnosis-to-test linkage on every Medicare claim before submission.
National coverage policy restricts tumor marker testing, such as PSA, CA-125, and CEA, to specific diagnosis codes, clinical scenarios, and surveillance intervals. TransLabs monitors each patient's testing history against these limits and flags ordering patterns before a claim is submitted, preventing denials that are nearly impossible to appeal after the fact.
When a Medicare beneficiary requests a genomic panel or companion diagnostic test that may not meet medical necessity criteria under the applicable LCD or NCD, a valid ABN must be issued before the specimen is processed. TransLabs builds ABN workflows into front-end intake specifically for high-cost oncology testing.
The CLFS sets Medicare payment rates for oncology and hematopathology lab tests and updates annually on January 1. TransLabs monitors CLFS changes, updates billing tables immediately at each rate change, and flags underpayments against genomic and molecular test rates before filing deadlines pass.
Laboratories meeting the applicable laboratory definition under the Protecting Access to Medicare Act carry mandatory private payer data reporting obligations, with particular scrutiny on high-cost molecular and genomic test pricing data. TransLabs tracks your PAMA obligations and ensures accurate, on-time reporting.
The Office of Inspector General's annual Work Plan has repeatedly flagged tumor marker testing, genetic and genomic testing, and laboratory-developed test billing for active audit scrutiny. TransLabs builds compliance protocols specifically around current OIG focus areas to reduce your audit exposure before it becomes a problem.
Most billing companies treat oncology labs like physician practices or general labs. They’re not the same business. Oncology billing has its own CPT/PLA codes, MolDX requirements, LIS/pathology workflows, and payer scrutiny. TransLabs’ dedicated team works only in oncology and hematopathology; no divided attention, no generalist assumptions.
Dedicated billing specialist assigned to your lab
Complimentary 12-month claims audit across Medicare, Medicaid, and commercial payers
Uncover your top 3 revenue leaks (Z-Code gaps, tumor marker denials, modifier errors)
Custom strategy tailored to your test menu 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
