Healthcare IT Blog

Losing revenue between the order and the deposit? See how ADS laboratory billing software checks claims before they go out. Your lab just posted its best test volume in three years. Collections didn't keep pace. Somewhere between the order and the deposit, revenue is leaking through modifier errors, LCD mismatches, and claims that never cleared a payer edit. Nobody on staff has time to trace where.

Your lab ran the panel correctly. The science isn't in question. But the claim came back denied because a Z-code was missing, and now your compliance manager is wondering if this is a billing problem or the start of something bigger. In 2026, it's often both.

Independent clinical laboratories spent much of 2026 preparing for one major date: July 31. That was the close of the latest PAMA private payer reporting window. Applicable laboratories submitted rate and volume information that CMS will use to help establish Clinical Laboratory Fee Schedule payment rates for 2027 through 2029.

A laboratory receives a denial. Someone investigates it, corrects it, resubmits or appeals it, and eventually gets it paid. Then another claim gets denied for the same reason next month. That is not a billing win. It is expensive repetition. As independent laboratories prepare for 2027, one of the biggest opportunities is not simply working denials faster. It is preventing more of them before they happen.

Looking for laboratory billing software or RCM services? Visit our Laboratory Solutions page → to see how ADS supports labs like yours. For the past several months, independent laboratories across the country have been focused on one milestone:the July 31 PAMA reporting deadline. Finance teams gathered private payer data, laboratory leadership reviewed reimbursement information, and billing departments submitted the required reporting to CMS under the Protecting Access to Medicare Act.

A pathologist reads a biopsy, writes the report, and moves on to the next specimen. Weeks later, the claim comes back denied because the technical and professional components were split incorrectly. The clinical work was right. The billing was not, and now someone has to fix it.

Run a clinical laboratory? Visit our Laboratory Solutions page → to see how ADS supports labs like yours. If you run a clinical laboratory, this month marks a turning point. The PAMA private payor data reporting window, running May 1 through July 31, 2026, is closing now. What labs submit to CMS this summer will directly determine Medicare Clinical Laboratory Fee Schedule (CLFS) reimbursement rates beginning January 1, 2027.

Run a clinical laboratory? Visit our Laboratory Solutions page → to see how ADS supports labs like yours. For many laboratories, the biggest reimbursement threat is no longer claim denials. It is clawbacks. Insurance clawbacks occur when a payer recovers money that was previously paid to a laboratory, often months or even years after the original claim was processed. While many labs focus heavily on getting claims paid, far fewer are prepared to defend revenue that has already been collected.

Run a clinical laboratory? Visit our Laboratory Solutions page → to see how ADS supports labs like yours. A test is ordered. The sample arrives. Your team processes it correctly. The claim goes out on time. And then it comes back denied — not because anything was done wrong, but because there is no Local Coverage Determination governing that code, and the payer had no framework for evaluating whether it should pay.

Laboratories across the country are facing a growing operational challenge: finding and retaining qualified laboratory billing staff. What was once considered a back-office function has become one of the most critical and difficult positions to fill in the laboratory industry. From clinical labs and pathology groups to molecular and toxicology laboratories, many organizations are struggling with staffing shortages, employee turnover, payer complexity, and increasing billing compliance demands.