When was the last time you reviewed your revenue from clinical pathology?

If you’re like most pathology groups, you may be overlooking a critical component that could be worth 40% to 60% of your total collections: the professional component (PC) of clinical pathology services.

At Infinx, we’ve seen this happen time and again—groups doing the work, but not getting paid for it. And the reason is often rooted in outdated billing practices, misunderstood managed care contracts, or incomplete data.

Let’s break down where the money is going—and how to get it back.

Why the Professional Component Gets Overlooked

In the quest for simplicity, many billing companies steer pathology groups into managed care agreements that exclude clinical pathology’s professional component. Their reasoning? It’s easier to process fewer claims.

But easier isn’t always better.

Here’s what that oversight can cost you:

  • Missed collections from supervised lab work
  • Unbilled services from ER, point-of-care, or chemistry labs
  • An ongoing pattern of underpayment that becomes the norm

Our subject matter expert David Smith has found that when his team audits new clients, 95% are missing data from the hospital systems they bill. That’s not a small gap—it’s a gaping hole in the revenue cycle.

3 Signs You’re Missing Clinical Pathology Revenue

Before assuming your billing is buttoned up, ask yourself:

  • Are you billing for the professional component (modifier 26) of clinical pathology services? Many practices do not capture all the lab departments and some capture nothing at all.
  • Have you reviewed your managed care contracts? If your contracts don’t explicitly reimburse for clinical pathology PC, you may be working for free.
  • When was the last time you audited your coding and documentation? Without a regular review, your billing partner may be missing entire departments, services, or modifiers.

Why This Matters Right Now

Managed care companies don’t pay for what you don’t demand. Worse, they’re banking on you not knowing what you’re entitled to bill for. That’s how they save money—by underpaying pathology practices that don’t push back.

And here’s the truth: Hospitals typically aren’t billing for this either—and they’re not going to stop you from going after the payments you’ve earned.

If you’re not being reimbursed for professional oversight of clinical lab services, that’s lost income you could be using to invest in staffing, technology, or better patient outcomes.

What You Can Do Today

✔️ Audit your contracts: Ensure clinical pathology PC is clearly outlined and reimbursed.

✔️ Review your billing files: Verify all hospital departments under pathologist supervision are being billed.

✔️ Appeal denials aggressively: Even small-dollar claims matter. They preserve your right to litigate if needed.

✔️ Partner with an RCM firm that will fight for every dollar: Not all billing teams are built the same.

Final Takeaway

The professional component of clinical pathology isn’t a nice-to-have—it’s core revenue for pathology groups. If your billing partner isn’t capturing every eligible charge or isn’t fighting denials, it’s time to take a hard look at your process.

Because what you’re not collecting today could be the difference between getting by and growing tomorrow.

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