---

1. Submitting Claims with Incorrect Patient or Provider Information

The Problem:
Lab claims often bounce back because of mismatched patient demographics or wrong ordering provider details. Even a missing middle initial or incorrect NPI can cause rejection.

The Fix:

• Double-check all patient data before submission.
• Verify the referring provider’s NPI and taxonomy on each claim.
• Use automated eligibility verification tools in your billing software.

2. Using Incorrect CPT or HCPCS Codes

The Problem:
Labs frequently use outdated or incorrect CPT codes for diagnostic panels or molecular tests. This leads to claim denials or partial payments.

The Fix:

• Update CPT and HCPCS codes quarterly.
• Match each test to its correct code based on payer policy.
• For molecular or genetic tests, include Z-codes or additional identifiers if required by payers.

3. Missing or Incomplete ICD-10 Diagnosis Codes

The Problem:
Payers deny lab claims that lack proper medical necessity documentation or supporting diagnosis codes.

The Fix:

• Ensure the ordering provider includes a valid ICD-10 code for each test.
• Match diagnosis codes with payer-approved lists.
• Attach documentation that supports the necessity of the test (physician order, clinical notes, etc.).

4. Not Following Payer-Specific Rules

The Problem:
Each insurance company has unique claim-filing rules some require modifiers, some demand electronic attachments, and others limit test frequency.

The Fix:

• Keep an internal database of payer-specific billing rules.
• Check claim submission guidelines regularly.
• Audit claims monthly to ensure compliance.

5. Incorrect Use of Modifiers

The Problem:
Labs often misuse modifiers like 59, 91, or 26, leading to rejected or down-coded claims.

The Fix:

• Train billing staff on correct modifier usage.
• Use 91 for repeat clinical lab tests, 59 for distinct procedural services, and 26 for professional components.
• Review payer documentation to confirm when modifiers apply.

6. Failing to Capture Secondary Insurance

The Problem:
Many patients have secondary coverage, but labs fail to submit secondary claims—resulting in lost revenue.

The Fix:

• Always ask for secondary insurance during registration.
• Submit primary claim first, then secondary once the EOB is received.
• Automate secondary claim submission where possible.

7. Missing Timely Filing Deadlines

The Problem:
Most payers only allow 90–180 days to submit claims. Labs with slow workflows often miss this window.

The Fix:

• Submit claims within 24–48 hours of service.
• Use billing software to track filing deadlines by payer.
• Consider outsourcing to a professional RCM company for on-time submissions.

8. Lack of Denial Tracking and Follow-Up

The Problem:
Many labs don’t track denial reasons or resubmit corrected claims promptly, losing thousands in uncollected revenue.

The Fix:

• Implement a denial management dashboard.
• Categorize denials (coding, eligibility, documentation, etc.) to identify trends.
• Resubmit corrected claims within the payer’s appeal window.

9. Poor Communication Between Ordering Providers and Labs

The Problem:
Missing orders, unsigned requisitions, or unclear test details delay claims and payments.

The Fix:

• Maintain consistent communication with ordering providers.
• Use electronic orders and signatures where possible.
• Educate providers on complete order requirements.

---

Final Thoughts

Reducing lab billing errors requires structure, automation, and payer-specific expertise. A clean claim submission process can increase lab revenue by up to 30% and reduce administrative costs.