Laboratory Solutions for Physician Practices
Evaluate the Opportunity. Understand the Requirements. Build the Right Strategy.
Adding or expanding laboratory services can improve diagnostic workflows, patient convenience, and practice operations. But a successful laboratory requires much more than testing equipment.
From compliance and technology to payer requirements, billing, staffing, and ongoing performance, Peregrine Healthcare helps physician practices evaluate the complete operational and revenue cycle picture before moving forward.
Is a Laboratory Right for Your Practice?
Before investing in laboratory services, practices should evaluate whether the opportunity aligns with their clinical needs, patient population, operational capabilities, and financial goals.
Key considerations include:
- Clinical need and testing volume
- Laboratory type and testing complexity
- CLIA certification requirements
- Staffing and laboratory oversight
- Equipment, supplies, and maintenance
- LIS and EHR integration
- Payer participation and coverage requirements
- Coding, billing, and medical necessity
- Quality control and compliance
- Long-term financial sustainability
The goal isn’t simply to add a laboratory. It’s to determine whether the right laboratory model can work successfully and sustainably within your practice.
Understanding Your Laboratory Options
Point-of-Care
Testing
Testing performed at or near the site of patient care. Regulatory requirements depend on the specific testing performed and its CLIA complexity classification.
Physician Office
Laboratory
Laboratory testing performed as part of a physician practice’s operations under the appropriate CLIA certification and regulatory requirements.
High-Complexity
Laboratory
Advanced testing that requires qualified laboratory personnel, specialized equipment, comprehensive quality systems, and greater regulatory oversight.
Off-Site Laboratory
Operations
Depending on the organization’s structure and needs, laboratory operations may also be established separately from the physician office.
Not every physician practice needs the same laboratory model.
Pain Management
Toxicology and medication-monitoring needs can make laboratory workflows particularly important for pain practices.
Primary Care & Internal Medicine
Routine diagnostic testing and ongoing monitoring play an important role in preventive care and chronic disease management.
Orthopedics & Sports Medicine
Laboratory testing may support diagnostic evaluation, treatment planning, and broader patient health assessment.
Rheumatology
Diagnostic, inflammatory, autoimmune, and medication-monitoring testing may be incorporated into ongoing patient management.
Gastroenterology
Laboratory testing can support diagnosis, disease monitoring, and ongoing treatment decisions.
OB/GYN
Women’s health practices frequently utilize diagnostic and preventive laboratory testing throughout different stages of care.
Wellness & Longevity Medicine
Biomarker and health-monitoring testing may support appropriate preventive and wellness programs.
Telemedicine
Coordinated laboratory testing can provide diagnostic information needed to support appropriate remote patient care.
The right laboratory model depends on your specialty, testing needs, patient volume, payer mix, and operational capabilities.
Look Beyond the Laboratory
Adding a Service Line Can Affect Your Entire Revenue Cycle
This is where Peregrine’s experience matters. Laboratory services can touch multiple areas of your practice.
Credentialing & Enrollment
Identify applicable enrollment, credentialing, and payer requirements.
Managed Care Contracting
Evaluate payer participation, contract terms, fee schedules, and reimbursement considerations.
Patient Access
Establish workflows for coverage verification, orders, documentation, and payer requirements.
Coding & Billing
Develop processes for accurate coding, claim submission, payment posting, follow-up, and denial management.
Compliance
Address medical necessity, documentation, regulatory requirements, and internal controls.
Performance Monitoring
Track laboratory revenue cycle and operational performance to identify potential problems early.
Laboratory Technology & EHR Integration
A laboratory should complement your clinical workflow, not create another disconnected system.
Practices may need to evaluate:
- Laboratory Information Systems (LIS)
- EHR/EMR integration
- HL7 interfaces
- Electronic test ordering
- Electronic result delivery
- Specimen tracking
- Reporting and analytics
- HIPAA-compliant data handling
Technology planning should begin early so clinical, laboratory, and revenue cycle workflows can work together effectively.
Compliance Comes First
Laboratory testing is subject to federal and, in some cases, state regulatory requirements.
Under the Clinical Laboratory Improvement Amendments (CLIA), laboratories testing human specimens for health assessment or for the diagnosis, prevention, or treatment of disease are generally subject to federal requirements, with specific requirements varying based on the testing performed.
Practices should evaluate applicable CLIA requirements, personnel qualifications, quality systems, documentation, medical necessity, payer policies, and other regulatory obligations before implementation.
How Peregrine Healthcare Can Help
One Decision. Multiple Operational Considerations.
Since 2001, Peregrine Healthcare has helped physician practices navigate the operational and financial complexities of running a successful medical practice.
When evaluating laboratory services, we help practices look beyond the laboratory itself:
Whether you’re considering laboratory services for the first time or evaluating an existing operation, Peregrine can help identify operational gaps, revenue cycle considerations, and areas requiring further evaluation.
Free Physician Resource
The Physician’s Guide to High-Complexity Laboratory Solutions.
What Every Practice Should Know About Compliance, Technology, and Laboratory Operations
Our physician-focused guide provides practical information for practices considering laboratory services, including:
- Laboratory models and testing complexity
- CLIA and compliance considerations
- Technology and EHR integration
- Staffing and operations
- Laboratory performance
- Questions to ask a laboratory partner
Can a physician practice operate its own laboratory?
Physician practices can operate laboratory services when applicable federal and state requirements are met. Requirements vary based on the type and complexity of testing, laboratory structure, personnel, and location.
What is CLIA certification?
The Clinical Laboratory Improvement Amendments establish federal quality standards for most laboratory testing performed on human specimens for health assessment or the diagnosis, prevention, or treatment of disease.
What is a high-complexity laboratory?
High-complexity laboratories perform tests classified as high complexity under federal regulations and are subject to more extensive requirements involving personnel, quality systems, proficiency testing where applicable, and laboratory oversight.
What should a practice evaluate before adding laboratory services?
Clinical need, testing volume, compliance requirements, staffing, technology, payer participation, reimbursement, billing processes, operating costs, quality management, and long-term sustainability should all be considered.
Can laboratory systems integrate with an EHR?
Many Laboratory Information Systems can exchange orders and results with EHR/EMR platforms through interfaces such as HL7. Capabilities depend on the systems and laboratory workflow involved.
How can laboratory services affect the revenue cycle?
Laboratory services can introduce additional enrollment, payer, coding, documentation, medical necessity, claim submission, denial management, and reimbursement considerations.
Need a Laboratory Operations Partner?
If your practice determines that laboratory services are a good fit but needs additional expertise, Peregrine works with a trusted laboratory partner with decades of industry experience in laboratory setup and operations.
We’re happy to make the connection.
Ready to Evaluate Your Laboratory Opportunity?
Peregrine Healthcare can help you look at the complete picture before you move forward.
From revenue cycle and payer considerations to credentialing, workflows, and operational strategy, our team helps physician practices make informed decisions and build stronger operations.
Call 877-463-1110
Based in Texas and Arizona. Trusted nationwide.