Precision Revenue Intelligence
Support accurate pathology coding, medical necessity validation, claims processing, and reimbursement visibility across complex diagnostic services.
Eight Streams. One Connected Revenue Cycle.
Precision Revenue Intelligence
Sample
Illustrative sample. Not a customer result.
Photographs show the care setting. RSAI does not examine patients, prepare medication, read specimens, or perform surgery.
Pathology revenue cycle management is specimen-based. One accession can contain several specimens, a professional read, a technical preparation, and special stains. Each of those can be a different billing question.
The clinical laboratory workflow, from accession to sign-out, is not the same thing as the claim. RSAI does not replace the laboratory.
Codes 88300, 88302, 88304, 88305, 88307, and 88309 describe increasing levels of surgical pathology examination. The correct level follows the specimen and the work in the report, not the organ name alone.
88342 represents an initial immunohistochemistry or immunocytochemistry antibody stain. A second antibody is a different code family. Not every stain is separately reimbursable.
Pathology is often split between a professional component, reported with modifier 26, and a technical component, reported with modifier TC. A global claim is appropriate only when the same party performed both and the payer allows it.
Billing both a global service and a component, or billing a component the group did not perform, is a common denial and a compliance problem. Modifier requirements are payer-specific.
A valid CPT code is not the same as a covered service. Medical necessity ties the diagnosis to the specimen and the stain. Medicare Administrative Contractors publish local coverage policies that commercial plans may or may not follow.
Specimen-related billing has to identify the specimen the report describes. An extra block or an extra stain needs its own support in the report. Volume is not a reason to unbundle.
Pathology groups submit large numbers of similar claims. The useful control is a repeated edit: component modifiers, units, diagnosis pointers, and duplicate accessions. StreamClaim is aimed at that kind of validation.
Validation is a check. It is not a promise the payer will pay, and it is not fully autonomous coding.
Many routine pathology services do not use the same prior-authorization path as a surgery or a biologic. Some advanced tests do. When an authorization applies, a missing number denies an otherwise coded claim.
Pathology reimbursement then depends on the fee schedule, the component split, and the coverage policy. RSAI does not publish a laboratory’s expected margin.
StreamCode can assist staff who assign levels and stain codes from the report. StreamClaim and StreamStatus help validate and follow the claim. People remain responsible for the diagnosis and the code.
RSAI differs from an outsourced billing company because the group keeps the work, the contracts, and the staff. The product is a platform fee plus credits, not a percentage of pathology collections.
Pathology claim denials cluster: medical necessity, component modifiers, duplicate claims, and stains the payer bundles. An underpayment is a paid line below the contracted amount. Grouping by reason is how a high-volume lab sees the pattern.
Figures on this page are illustrative. They are not a laboratory’s results.
Workflow
Pathology has a clinical laboratory workflow and a revenue cycle workflow. RSAI addresses the revenue cycle. It does not accession specimens, read slides, or sign a diagnosis.
Coding intelligence
Representative surgical pathology codes. Short categories, not AMA long descriptors. CPT is a registered trademark of the American Medical Association. Confirm the current code, the specimen, and the payer policy.
Swipe sideways to read every column.
| Code | Category | What to confirm |
|---|---|---|
| 88300 | Surgical pathology, gross examination only | The lowest examination level. Not a default for every specimen. |
| 88302 | Surgical pathology, level II examination | Level follows the specimen and the work, not a standing charge. |
| 88304 | Surgical pathology, level III examination | Confirm the specimen examples in the current CPT listing before selecting a level. |
| 88305 | Surgical pathology, level IV examination | A frequent level. It is still specific to the specimen. It is not a flat rate for the accession. |
| 88307 | Surgical pathology, level V examination | Requires the more extensive specimen work the code describes. |
| 88309 | Surgical pathology, level VI examination | The most extensive level in this series. Not appropriate because a case is complex in conversation. |
| 88342 | Initial immunohistochemistry antibody stain | One initial stain. Additional antibodies and multiplex stains have their own codes. Not every stain is paid separately. |
Do not read this list as a rule that every specimen, block, or stain is separately reimbursable. Professional and technical components depend on who performed the work. Modifier 26 and modifier TC are not both billed by the same party on the same service.
HCPCS units are paraphrased from the CMS quarterly file. Confirm the current CMS HCPCS update. Discarded-drug reporting, when it applies, is described by CMS discarded-drug policy. Global surgery rules live on the Medicare physician fee schedule. CPT® is a registered trademark of the American Medical Association. RSAI does not reproduce AMA long descriptors.
Streams
The streams below are the ones most used for this specialty. They are part of the same eight. Stream Orchestrator is the coordination layer. It is not a ninth stream.
Assists coding review from the pathology report. It does not sign out a diagnosis.
Validates component modifiers, units, and repeated denial patterns before and after submission.
Patient balances that remain after the payer prices the pathology claim.
Follows high-volume claims so a repeated denial reason is visible.
All eight streams: StreamDesk, StreamVerify, StreamAuth, StreamCode, StreamClaim, StreamBill, StreamCall, StreamStatus. See the stream suite.
Questions
No. Pathologists diagnose. RSAI supports coding, claim validation, and reimbursement follow-up from documentation the laboratory already created.
No. Some stains are bundled, some need a covered diagnosis, and some are limited by the payer. 88342 is a representative initial-stain code, not a blanket rule.
No. Those modifiers split professional and technical work. They apply only to the component the billing party performed, under that payer’s rules.
No. RSAI is revenue cycle automation the group’s own team uses. It is not an outsourced medical billing service.
Keep the laboratory in charge of the diagnosis. Use the platform for coding review, claim validation, and reimbursement follow-up.