Healthcare IT Blog

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.

ADS has been in healthcare for 49 years. Since 1977 we’ve watched this industry move from paper claims to clearinghouses, from filing cabinets to the cloud, from the Yellow Pages to Google. That vantage point teaches you the difference between a passing fad and a real shift, so pay attention when we say this: the way patients find a practice is changing faster right now than almost anything we’ve seen in five decades.

Revenue cycle management covers everything that happens between a patient scheduling an appointment and your practice actually getting paid for the care delivered. That sounds simple. In 2026, it is anything but.

Denial rates are climbing. Prior authorization is consuming staff time organizations can't afford to lose. And most BH systems weren't built to handle any of it. Here's the reality — and what the practices holding their ground are doing differently.

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 behavioral health practice? Visit our Behavioral Health Solutions page → to see how ADS supports practices like yours. A per diem claim for a residential patient comes back denied. The level of care does not match the authorization on file. The consent form for the disclosure is outdated under the new federal rule. And your utilization review team is now reconstructing three weeks of documentation to defend a stay that already happened.

Your billing manager is still finishing last year's MIPS submission when this year's reporting period opens. Quality measures need updating. Cost data needs review. And somewhere between patient visits, someone has to track improvement activities too.

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 behavioral health practice? Visit our Behavioral Health Solutions page → to see how ADS supports practices like yours. Something changed on January 31, 2026 that most behavioral health practices are not ready for. Medicare updated its telehealth requirements for mental health services, and the consequences of non-compliance are not warnings or penalties. They are automatic claim denials with no path to appeal. If you have Medicare patients receiving telehealth services today and you are not tracking their in-person visit history, you are already at risk.

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.