Radiology and Lab Billing
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One Scan Or Test Without Authorization Is Revenue You'll Never See Again.
Referral coordination, benefits verification, and billing built for the way radiology and lab services actually get paid.
Every radiology study or lab test starts with an order and ends with a reimbursement, and a lot can go wrong in between. Missing authorization, unclear medical necessity, and coding errors on high volume panels are the leading drivers of denials in radiology and lab billing alike. MediCommerce provides Core Billing, Staffing Solutions, and Health Care Operations built around that reality, with authorization and documentation handled before the claim is ever at risk.
What We Do For You
Core Billing Services
MediCommerce manages the full billing cycle for radiology centers and diagnostic labs, including accurate coding across every modality or panel you offer and correct application of the professional and technical component split, one of the most commonly missed billable areas in radiology. For labs, we apply correct panel and bundling edits to avoid unbundling denials, and confirm medical necessity and ABN documentation is in place before a non covered test is run. We follow up on AR aggressively so denied or underpaid claims never sit unresolved.
Health Care Operations
We coordinate incoming orders and referrals from ordering physicians, verify patient benefits before the study or test is scheduled, and manage prior authorizations, including navigating radiology benefit managers like eviCore and Carelon, so your organization never performs a service that will not get paid. For multi site radiology groups and labs, we also standardize billing operations across locations while still accounting for local payer nuance.
Staffing Solutions
For radiology centers and labs that want dedicated coding, authorization, or billing staff without adding full time headcount, MediCommerce places experienced RCM professionals into exactly the roles you need, billed at a fixed cost. Staffing scales with your study or test volume, so support grows as volume grows, not before.
Why This Partnership Matters
A radiology claim carries real cost the moment a study is performed, the equipment time, the technologist, the radiologist read, all spent before a claim is ever submitted. If authorization was never confirmed or medical necessity was never documented clearly, that cost cannot be recovered. MediCommerce is built to catch that risk before the scan happens, not after the denial arrives.
Why Radiology and Lab Providers Choose MediCommerce
MediCommerce brings deep experience in the things that make or break reimbursement in this space, authorization, medical necessity documentation, and panel and bundling accuracy, handled before a service is performed rather than corrected after a denial. We understand the professional and technical component split, modifier accuracy, radiology benefit manager navigation, and lab specific coding rules, so your organization is not learning these lessons claim by claim.
FAQ
What are the biggest causes of denials for radiology and lab claims?
Missing prior authorization and unclear or incomplete medical necessity documentation are the leading drivers for radiology. For labs, incorrect panel or bundling edits are just as common. We address all of these before the service is performed, not after the claim is denied.
How do you prevent unbundling denials on lab panels?
We apply correct panel and bundling edits based on current payer rules, and confirm medical necessity and ABN documentation are in place before a non covered test is run, so a lab is not left absorbing the cost of a test that was never going to be reimbursed.
Do you handle authorization through radiology benefit managers like eviCore or Carelon?
Yes. We navigate radiology benefit manager requirements directly as part of the authorization process, so your front desk is not left managing that back and forth.
What is the professional and technical component split, and why does it matter?
Many radiology studies involve both a professional component, the radiologist’s read, and a technical component, the equipment and staff time. Billing these correctly and separately is one of the most commonly missed areas in radiology, and getting it wrong leaves revenue on the table.
Can you support multiple radiology locations with different payer contracts?
Yes. For multi site radiology groups, we standardize billing operations across locations while still accounting for the payer specific nuances each site may have.