Opportunity for inappropriate test billing and misuse of send‑out workflows due to weak tracking controls

$10,000–$100,000+ per year in downstream write-offs, payer denials, and clawbacks for non‑covered or non‑medically necessary send-out tests that slipped through weak tracking and utilization controls, plus unbillable tests when supporting documentation cannot be reconstructed. • $10,000–$30,000 per year in non‑reimbursed or non‑allowable testing absorbed by the lab or health department budget because invoices cannot be effectively challenged. • $10,000–$40,000 per year in paying for unapproved or non‑ordered tests because the lab cannot produce a clear digital trail that disputes the reference lab’s invoice line items.

Billing staff perform post‑facto chart reviews and manual reconciliations between reference lab invoices, LIS reports, and public health program rules using spreadsheets and paper files to decide which send‑out charges to hold, write off, or risk submitting. • Phlebotomists and send‑out staff rely on handwritten notes on paper requisitions, ad hoc barcode relabeling, and verbal clarification with nurses or physicians to reconcile what was actually intended when the order in the EHR/LIS does not match the specimen or reference lab menu. • Phlebotomists track send‑out specimens using route logs, paper manifests, and occasional Excel trackers to remember which patient’s sample went to which reference lab and what was roughly ordered, without a reliable, shared digital trail.