Running a pathology lab already comes with enough challenges, from ensuring accurate results to managing operations. But too often, labs across the U.S. lose thousands each month because of outdated assumptions about pathology billing and coding. The truth? Modern, specialized revenue cycle management (RCM) can turn your billing process into a reliable source of growth, not frustration.

Myth #1: “Our LIS Handles Billing Just Fine”

• Reality: Laboratory Information Systems (LIS) are excellent for workflow management, accessioning, reporting, and tracking QC. But when it comes to billing, LIS platforms simply aren’t built to handle payer rules, denial management, or payment reconciliation.
• Solution: Integrating your LIS with dedicated pathology billing software ensures charges are captured accurately, clean claims are submitted, and your team stays focused on testing rather than chasing claims.

Myth #2: “Pathology Coding Is Simple”

• Reality: Coding in pathology extends far beyond the basic 88300–88309 codes. It includes molecular testing, add-on codes for stains, IHC, and FISH. Missing just one CPT code or modifier like 26/TC can translate into significant revenue loss.
• Solution: Partner with certified coders supported by AI-driven workflows. This ensures every CPT code is captured, modifiers are applied correctly, and documentation is validated before submission.

Myth #3: “Claim Denials Are Unavoidable”

• Reality: Most pathology claim denials are preventable. Errors like missing ICD-10 codes, incorrect modifiers, or medical necessity issues are entirely avoidable with the right processes in place.
• Solution: Use real-time eligibility checks and pre-bill audits to prevent denials before claims go out. Labs that adopt automated front-end verification reduce eligibility-related denials by up to 30%.

Myth #4: “We’ll Notice Underpayments Eventually”

• Reality: Without analytics, many underpayments go undetected. Labs often miss discrepancies between payer contracts and actual reimbursements, leaving money behind that’s rightfully theirs.
• Solution: Use a real-time RCM dashboard to monitor AR days, denial trends, and reimbursement accuracy. Tracking these KPIs ensures faster collections and helps identify payer issues early.

Myth #5: “Audits Are Only About Compliance”

• Reality: Coding audits are not just about meeting CMS and payer requirements. They also reveal unbilled add-on codes, downcoded claims, and missed opportunities that directly impact your revenue.
• Solution: Conduct quarterly audits — both retrospective and pre-bill, to protect compliance and recover missed revenue. Labs that prioritize audits often see a 3–7% revenue lift.

Myth #6: “Automation Replaces Billing Teams”

• Reality: Automation doesn’t eliminate your billing staff, it empowers them. Repetitive tasks like claim status checks and data entry drain time and increase burnout.
• Solution: Automate routine processes so your billing team can focus on high-value tasks like denial resolution and revenue optimization. The result? Lower AR days and more predictable cash flow.

Final Takeaway

Pathology billing doesn’t have to drain your resources or revenue. By busting these common myths and leveraging specialized expertise, labs can achieve:

• Accurate coding and clean claims
• Reduced denials and write-offs
• Faster collections
• Stronger financial stability

At Konnext Solutions, we help pathology groups simplify billing, reduce errors, and unlock the revenue they’re missing.

Ready to see the difference? Contact us today to schedule a pathology billing assessment.