Healthcare IT Blog

Your lab ran the numbers for 2027 budgets this summer. Then CMS posted its preliminary Clinical Laboratory Fee Schedule rates on September 22, and those numbers stopped working.

A lab director sits through a fourth vendor demo this quarter. Every platform promises automation and AI-powered accuracy. None of them can answer a direct question: does this system actually know what an LCD is, or does it just process claims and hope the compliance team catches the difference?

It's 9:47 p.m. The kids are asleep. Your clinician is still on the couch finishing notes from a nine a.m. session. That is not a productivity problem you can staff your way out of. It is what happens when a general purpose EHR asks a behavioral health clinician to document a longitudinal treatment relationship using fields built for a fifteen-minute physical exam.

Nobody picks a bad EHR on purpose. You picked the one that made sense at the time, and for a while it did the job. The problem is that podiatry has changed a lot in the last few years, and a lot of systems have not changed with it. Coding got more complicated. AI went from a gimmick to something that actually writes your note. Payers are moving to electronic prior authorization. And your vendor's answer to all of it has been a price increase and a new logo.

A psychiatrist documents a thorough 55-minute medication management session with a patient managing treatment-resistant depression. Clinically, nothing about the visit was ambiguous. On the claim, the time was rounded incorrectly against the CPT code's threshold, and the entire visit gets denied instead of downcoded, turning a billable encounter into unpaid work.

Key takeaways CMS's preliminary 2027 Medicare Clinical Laboratory Fee Schedule (CLFS) rates average a 16% weighted cut, with up to 15% per test on January 1, 2027. Nearly 1,200 tests are affected, and more cuts are scheduled for 2028 and 2029. CMS expects final rates in November 2026, the same month as the AMP 2026 Annual Meeting and Expo in Seattle. ACLA, CAP, the AHA and the Association for Molecular Pathology (AMP) are backing the RESULTS Act, which would freeze rates for 2027 and 2028. It has not passed yet. Labs that model their top-code exposure and fix denial and underpayment leakage now will absorb the cuts best. The October issue of Laboratory Economics led with the number lab leaders have been bracing for: an average weighted cut of 16% in CMS's preliminary 2027 CLFS rates. With final rates due in November and the molecular community meeting in Seattle for AMP 2026 (#AMP2026) the same month, the cuts will be the topic on the expo floor.

The wound care claim came back denied. Again. Not because the treatment was wrong. Because the note did not prove it was medically necessary. Now your biller is fighting an appeal, the workers' comp adjuster wants more paperwork, and the patient's attorney is asking why the file has not moved.

An EMG denial rarely says "wrong code." It says bundling, units, or medical necessity. By the time it lands, the study is done, the patient is gone, and your team is rebuilding the claim from memory.

Most podiatry practices lose money in Q4 the same way every year. Not through one big mistake, but through a dozen small ones that all come due at the same time: aging claims nobody worked, patient balances that roll into a new deductible year, and coding changes that never made it into the system.

Every laboratory has denials. The more useful question is why your laboratory keeps having the same ones.