Audits and Recoupments from Improper Lab Coding Practices

$0 direct to credentialing specialist, but $100M+ aggregate impact to Medicare/Medicaid from non-compliant labs remaining in network longer than necessary; fraud liability exposure • $100,000 - $300,000 annual recoupments from commercial payer audits; rework and appeals process costs additional $30,000 - $80,000 per year • $100,000 - $300,000 annually (payer recoupments + audit response overhead + staff FTE)

Administrator manually builds data extracts; coordinates with billing/compliance via email; performs manual coding corrections based on verbal direction; maintains separate spreadsheets • Administrator manually extracts Medicare-billable tests; builds spreadsheets for audit response; communicates via email with compliance officer; performs manual data validation • Administrator manually queries LIS for payer-specific tests; builds response spreadsheets; communicates via email; performs manual coding lookups