Healthcare IT Blog

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.

If your practice bills Medicare, January 1, 2027 is coming with a pay cut attached. In July, CMS released its proposed 2027 Medicare physician fee schedule, and for most physicians the conversion factor drops 1.68%, from $33.40 to $32.84. Qualifying APM participants fare slightly better, with a 1.19% drop to $33.17. Most of the cut comes from the expiration of the one-time 2.5% bump Congress provided for 2026. Small statutory updates of 0.25% and 0.75% do not make up the difference. A 1.68% cut sounds small. For a specialty practice with tight margins, rising costs and a heavy procedure mix, it rarely lands as 1.68%. The question is not whether Medicare reimbursement cuts are coming. It is how much they will cost you, code by code. Want your number now? Estimate your 2027 Medicare impact with our free calculator.

Waiting on authorizations while beds stay full? See how ADS supports enterprise health systems and rural hospitals from one record. A patient is medically ready to move to inpatient rehab. Your case manager is on hold with a Medicare Advantage plan, waiting on an authorization. The bed stays full. The ED backs up behind it. When the answer finally arrives, it's a denial.

Running inpatient status through three disconnected systems? See how ADS supports enterprise health systems and rural hospitals from one record. A patient sits in observation for 36 hours. Your physician is sure the stay needs inpatient care. Your case manager is on the phone with a Medicare Advantage reviewer who disagrees. Three weeks later, the claim comes back denied, and your team starts an appeal from scratch.

Every October 1, the same thing happens to practices that didn't prepare. A code your team has used for years stops working, the claim bounces, and nobody notices until the denial report runs. This year's ICD-10-CM update is smaller than most, which makes it easy to assume you can skip the prep. That assumption is exactly what causes the denials.

The healthcare industry's pivot towards value-based care (VBC) is particularly transformative for behavioral health, redefining how services are provided and compensated. This shift from traditional fee-for-service models, where providers are paid for the quantity of care, to models that prioritize the quality and outcomes of care represents a significant evolution in healthcare delivery. Advanced Data Systems Corporation (ADSC) stands at the vanguard of this shift, equipping behavioral health providers with the necessary tools and insights to thrive under these new conditions. Here’s an expansive look at the essential nature of value-based care in behavioral health.