- 4009 Hackney Springs Ln, Sachse, TX 75048
Serology and infectious disease billing moves faster than almost any lab discipline; new multiplex panels, PLA codes, and payer scrutiny arrive yearly, often reacting to the last outbreak or audit. Expanded syndromic panels that once sailed through now face target-count limits and non-coverage determinations. Generalist billers rarely track these changes, and revenue loss compounds quietly until an audit reveals months of costs.
Expanded Panel Medical Necessity Denials
NAAT Target-Count Miscoding
Reflex Confirmatory Testing Capture Gaps
Add-On Test Bundling With Primary Infectious Disease Testing
Screening vs. Diagnostic Coding Errors
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.
Many MACs and commercial payers now treat 6-11 and 12-25 target respiratory and GI pathogen panels as non-covered or covered only for beneficiaries with serious illness, immunodeficiency, or a documented severe underlying condition. TransLabs validates every expanded panel claim against the current coverage determination before submission, not after the denial.
Each MAC maintains its own LCD and companion coding article specifying which ICD-10 diagnoses support coverage for respiratory, GI, and other multiplex infectious disease panels. These policies are revised frequently as new PLA codes are added and older ones retired. TransLabs maintains live LCD databases and validates diagnosis-to-test linkage on every Medicare claim.
Two-tier protocols, such as Lyme disease screening followed by confirmatory immunoblot, or a reactive HIV screen followed by confirmatory testing, must show the reflex logic was followed correctly. TransLabs builds these reflex rules directly into claim validation so confirmatory testing is billed only when the record supports it.
Federal program integrity efforts have specifically flagged the practice of bundling unrelated add-on tests, such as allergy or genetic panels, alongside a primary infectious disease test without independent medical necessity for each service. TransLabs reviews ordering patterns for this exact risk profile.
When an expanded panel tier may not meet medical necessity criteria under the applicable LCD, a valid ABN must be issued before the specimen is collected. TransLabs implements ABN workflows into front-end intake specifically for expanded respiratory and GI panel ordering.
Preventive screening for HIV, hepatitis C, and select STIs falls under a different benefit category than diagnostic testing for symptomatic patients, with different cost-sharing rules. TransLabs codes each claim to the correct benefit category based on the documented reason for testing.
The CLFS sets Medicare payment rates for serology and infectious disease lab tests and updates annually on January 1, with molecular panel codes revised more frequently than most categories. TransLabs monitors CLFS changes and updates billing tables immediately at each rate change.
Most billing companies still bill infectious disease panels the way they did three years ago, missing the coverage changes that have reshaped expanded panel reimbursement since. TransLabs was built for laboratory billing exclusively, and our infectious disease team tracks payer policy changes as they happen, not months after a denial pattern has already cost you money.
Dedicated billing specialist assigned to your lab
Complimentary 12-month claims audit across Medicare, Medicaid, and commercial payers
Uncover your top 3 revenue leaks (expanded panel denials, reflex gaps, coding mismatches)
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
