Key Takeaways Medicare Administrative Contractors are denying claims that bill one unit of CPT 87798 for each organism detected by a single multiplex infectious disease panel. The National Correct Coding Initiative (NCCI) Policy Manual, Chapter 10, says a test for multiple infectious agents is reported with one unit when one procedure, one methodology, or one […]
What CMS’s Preliminary 2027 CLFS Rates Mean for Lab Reimbursement
Key Takeaways CMS released preliminary 2027 Clinical Laboratory Fee Schedule (CLFS) rates on Sept. 21, based on private payer data laboratories reported between May and July 2026. Of 1,528 lab codes with a private payer weighted median, 1,171 fall below their 2026 Medicare rate. CMS puts the average potential change at about 16% lower. Genomic […]
Labs Got a Reprieve on PAMA Cuts for 2026, But 2027 Is a Different Story
Key Takeaways Congress blocked scheduled Clinical Laboratory Fee Schedule cuts for 2026 through the Consolidated Appropriations Act, 2026, signed February 3, 2026. The 2026 PAMA reporting window ran May 1 through July 31, 2026, and has already closed. Labs reported private payer data from January through June 2025, not the outdated 2019 data originally planned. […]
Laboratory Billing Errors: Panel Coding, Modifier 91, and Consolidated Billing Gaps
Key Takeaways Organ and disease panel codes carry NCCI edits that block separate billing of individual components once the panel’s components have all been performed. Modifier 91 applies only to medically necessary repeat testing performed to obtain multiple results on the same day, not to work-arounds for frequency edits. Laboratories testing specimens for patients in […]
Toxicology Lab Billing: Why Payer Scrutiny Is Getting Harder to Navigate
Key Takeaways Payer scrutiny of toxicology lab billing has intensified significantly, with Medicare Administrative Contractors and commercial insurers applying stricter medical necessity and documentation standards. Definitive and presumptive drug testing require distinct coding approaches, and errors in distinguishing between them are among the most common sources of toxicology claim denials. Local Coverage Determinations vary by […]
White Paper: Why Laboratory Billing Breaks Down (And How LIS-RCM Integration Fixes It)
Why Seamless Integration Between Your LIS and RCM Systems Is Essential for Lab Financial Success Clinical laboratory billing often breaks down when laboratory information systems (LIS) and revenue cycle management (RCM) workflows operate separately. This white paper explains why the disconnect occurs and how integration helps laboratories reduce denials and improve reimbursement. Executive Summary Clinical […]
‘I Saw the Sign:’ Indicators It’s Time for a Laboratory to Outsource Its Billing
Key Takeaways Declining laboratory collections despite stable or growing test volume often indicate coding gaps, underpayment issues, or ineffective follow-up within the revenue cycle. Rising denial rates in laboratory billing typically reflect medical necessity errors, payer policy misalignment, or inconsistent documentation processes. Compliance pressure around molecular diagnostics, toxicology testing, and genetic panels requires proactive oversight […]
Why 2026 Is the Year Labs Should Rethink Billing and Revenue Cycle Management
Key Takeaways Laboratory billing is becoming more complex in 2026, not less. Reimbursement pressure, payer scrutiny, and staffing challenges are making in-house billing harder to sustain. Outsourcing laboratory billing and revenue cycle management can protect margins, improve cash flow, and reduce compliance risk. Not all billing companies are built for labs. Working with a partner […]
7 Top Reasons Laboratories Outsourced Their Billing in 2025
Key takeaways: Laboratories increasingly outsourced their billing in 2025 due to payer complexity, rising denial rates, staffing shortages, and the need for stronger financial visibility. Specialized laboratory billing partners provide deeper expertise in laboratory coding, compliance, toxicology lab billing, and overall laboratory RCM performance. Outsourced billing empowers labs to focus on core operations while strengthening […]
Lab Billing: How Expert Management Will Transform Your Laboratory’s Revenue
Running a laboratory today is more complex than ever. Between evolving payer rules, rising costs, staffing challenges, and the constant pressure to deliver fast, accurate results, billing can quickly become one of the biggest pain points in your operation. Lab billing isn’t just about getting claims out the door. It’s about protecting your revenue, ensuring […]