When it comes to pathology billing, the “easy way” can be the most expensive.

Many billing companies treat pathology like any other specialty—pushing out claims, signing quick contracts, and moving on. But pathology isn’t like other specialties. And if your billing partner doesn’t understand that, you could be losing millions of dollars a year without realizing it.

Here’s what’s really happening—and how to take back control.

The Billing Shortcuts That Hurt Pathology Groups

Too often, pathology groups are pushed into cookie-cutter billing models. The logic from their billing company goes something like this:

  • “Let’s sign that managed care contract—it’s easier than fighting.”
  • “We’ll just submit charges from the LIS and move on.”
  • “Don’t worry about the denials—it’s not worth chasing the small ones.”

Sound familiar?

This shortcut-first mindset leads to major revenue leakage, especially in hospital-based settings where pathology services are diverse, complex, and frequently overlooked in billing files.

Here’s what’s often missing:

  • Emergency room claims
  • Point-of-care testing
  • Entire hospital departments supervised by the pathologist
  • Charges requiring special modifiers or documentation
  • Appeals for denied clinical pathology services

David Smith, our SME with decades of pathology RCM experience, has seen it all. In 95% of new client audits, his team finds missing data, services, or payments that should have been captured.

Why “Set It and Forget It” Doesn’t Work in Pathology

Pathology billing isn’t static. Hospital systems change. New testing methodologies roll out. Payers shift their policies—sometimes quarterly, sometimes without warning.

If your billing team isn’t:

  • Regularly auditing coding and documentation
  • Customizing appeal processes per payer
  • Reviewing managed care contract terms
  • Updating workflows as hospital systems change

…then you’re falling behind.

Worse, you’re trusting someone else to care more about your revenue than you do.

The Real Cost of Complacency

What does all of this look like in dollars?

  • Up to 60% of total revenue may come from the professional component of clinical pathology.
  • A single missed department or unsubmitted claim series can equal hundreds of thousands of dollars annually.
  • Denied claims that go unappealed can never be litigated—closing the door on future recoupment.

Billing companies that take the “easy route” aren’t protecting your bottom line. They’re just checking boxes.

How to Get Back on Track

If you want to protect your revenue and reduce risk, here’s where to start:

  • Ask better questions:
    • Are we billing for everything we supervise in the hospital?
    • Are we being reimbursed for both anatomic and clinical pathology components?
    • When was our last audit?
  • Review every managed care contract: Look for clauses that exclude clinical pathology reimbursement—then challenge them.
  • Choose partners who do the hard stuff: Submitting claims is just the beginning. The real value comes from aggressive follow-up, accurate appeals, and the willingness to litigate when necessary.

Final Word

Pathology billing isn’t plug-and-play. If your current partner is prioritizing ease over accuracy, your revenue is paying the price. Don’t settle for the easy route. Demand the thorough one.

For more on this topic, watch David Smith’s webinar on-demand or request a demo here.