- +1 (773) 985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Pathology billing demands accuracy and Stream RCM delivers Pathology Medical Billing Services for laboratories that process high volumes of surgical, cytology, and molecular specimens. We combine our coding skills with the unique workflow of each payer to enhance your revenue integrity. Our team makes sure that every claim is filed correctly with the use of proper modifiers.
Stream RCM is an ideal partner for pathology practices with deep experience in anatomic, clinical, molecular pathology, hospital-based labs, and independent reference laboratories. Our coders are trained on surgical pathology reports, cytology interpretations, and immunohistochemistry panels. Our process is built around the reality of pathology practice where there is uncertainty in specimen volume, complicated modifier rules, and payers that review all claims associated with a diagnosis code. We monitor the details of CPT coding, ICD-10 linkages, and payer-specific modifier rules (like -26 and -TC). Our credentialing team makes sure that all pathologists are enrolled correctly with each payer to avoid revenue loss due to expired contracts. Our pathology billing company measures performance in the same way as our clients, using collection rate, denial rate, and days in accounts receivable.
We performed coding based on complexity of gross and microscopic examination of each surgical specimen with assignment of an appropriate 88300 family code before billing.
Our company provides accurate coding of Pap smears and non-gynecological cytology cases with proper differentiation between screening and diagnostic services according to the coverage requirements of payers.
Our expert team takes care about documentation and prior authorization necessary for successful processing of claims for molecular pathology services.
We provide proper coding with appropriate number of markers used for flow cytometry and bone marrow interpretation and avoid undercoding that is typical for this subspecialty.
We differentiate biopsy, excision and graft specimens and make sure our claims for skin pathology services correspond to the actual number of specimens.
Stream RCM handles the entire process of pathology revenue cycle management, from denial to payment posting, such that the laboratory collection is done effectively without any additional administrative effort.
We track down the origin of your pathology denials, whether it is improper modifier use or missing specimen information, or lack of authorization and fix the claims for submission in days, not in weeks.
The aged pathological claims are processed based on the payer, specimen type, and denial codes, meaning that the balances that are unpaid are recovered by our team within ninety days rather than being considered unrecovered revenue loss.
Our auditors review a random sample of surgical pathology records each month, looking for undercoding, overcoding, and missing modifiers compared to the physician’s documentation.
Our certified coders apply the CPT and ICD-10 codes based on the pathology reports without any loss of specimen-specific information, stain numbers, and modifiers accuracy.
We complete enrollment and re-enrollment of pathologists with all payers, eliminating the missing gaps that keep silent until they hold back reimbursements and do not allow new doctors to bill on their very first day of practice.
Every remittance gets posted against the original bill on a line-by-line basis therefore, underpayments, partial payments disguised as denials, and contract discounts get caught immediately rather than months later when reviewing finances.
Hand on pathology billing to a team that already speaks the language of specimens, modifiers, and payer policy.
The distinction is not evident in the sales process in pathology billing companies. It is only revealed once the transition period ends and operations start. At Stream RCM, we emphasize consistency and reliability through:
The distinction is not evident in the sales process in pathology billing companies. It is only revealed once the transition period ends and operations start. At Stream RCM, we emphasize consistency and reliability through:
| Procedure | CPT/ICD-10 | Description |
|---|---|---|
| Level IV surgical pathology | 88305/D48.1, C50.9 | We make sure that tissue diagnostic linking is done properly for breast, skin, and GI biopsies so as to get proper reimbursement. |
| Cytopathology (FISH) | 88185/N92.0, R87.6 | Our coders use appropriate molecular coding for urine and hematologic specimens with accurate diagnosis correlation. |
| Infectious disease detection | 87635/U07.1, J12.8 | We use the proper ICD-10 codes for COVID-19 and respiratory panels for medical necessity. |
| KRAS gene analysis | 81275/C18.2, Z15.0 | We link for colorectal and lung cancer diagnoses according to molecular pathology requirements. |
| Flow cytometry | 88346/D47.9, C81.0 | We have hematologic and lymphoid neoplasms coding using ICD-10 for specialized testing. |
The field of molecular and genomic testing keeps expanding. However, at the same time, payers impose stricter criteria for payment and reimbursement. Documenting information correctly is crucial to avoid rejections. Stream RCM assists by:
Our platform integrates directly with your Laboratory Information System (LIS) and EMR to make sure that every specimen is tracked from accession to final diagnosis without any disruption.
A regional anatomic pathology laboratory was handling approximately 4,000 surgical specimens monthly. The pathology lab sought assistance from us because of a more than 18% denial rate, which was primarily a result of modifier problems in multiple specimen procedures and credentialing issues with two pathologists.
Reduced the denial rate
Improved days in A/R
“According to the administrator of the lab, the most significant improvement was achieved through cooperation with coders knowledgeable in pathology reports.”
Pathology laboratories encounter recurring billing problems that silently reduce their income when they remain unresolved.
All pathology claims go through a similar five-step procedure which is designed to identify errors early before they get to the payer.
Our team reviews each pathology report against accession records to verify the number of specimens, their source, and the physician’s signature before any coding is done.
The certified coders in our team review the entire report and assign the CPT and ICD-10 codes that match the complexity of the report and its documentation.
Before we send off the claim, each claim undergoes edits based on payor rules for any modifiers, bundling, and frequency restrictions.
We do not leave any pathology claims abandoned. We appeal and provide supporting documentation where there are denied pathology claims.
Outsourcing removes the burden of tracking constant modifiers and payer policy changes in-house. Groups gain specialists who monitor pathology-specific rules daily, which typically lowers denial rates and shortens the time it takes to get paid.
Our team reviews every denial reason code, corrects the underlying documentation or modifier issue, and resubmits or appeals within payer deadlines. Patterns are tracked so recurring denial causes are fixed at the source, not repeatedly reworked.
Yes, consolidated billing across multiple locations and tax identification numbers is a core part of our service. We reconcile fee schedules and referral patterns by site so leadership sees one accurate financial picture across every location.
Yes, credentialing and billing are handled together because lapsed enrollment directly causes lost revenue. We track renewal dates and start new pathologist enrollment early so claims are never delayed by an expired or missing payer contract.
Most transitions take four to six weeks, covering data transfer, credentialing verification, and staff onboarding. We run parallel claim reviews during transition so no active accounts receivable balances are lost between billing systems.
Speak with a pathology billing specialist about your lab’s current denial rate.
