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.

In today’s complex healthcare environment, practices and health systems often struggle to maximize collections and minimize revenue loss because of inefficient or outdated billing and administrative workflows. If your organization wants to thrive — rather than simply survive — effective Healthcare Revenue Cycle Management (Healthcare RCM) must be a top priority. By modernizing processes, leveraging technology, and prioritizing patient financial engagement, you can substantially improve cash flow, reduce denials, and optimize reimbursements.

The following excerpt is from an article found on Revcycleintelligence.com. It was written by Catherine Sampson.

The following excerpt is from an article found on Medium.com. It was written by Hannah Williams.

The recent updates to the Clinical Laboratory Improvement Amendments (CLIA) by the Centers for Medicare & Medicaid Services (CMS) represent a significant overhaul, with implications that extend deep into laboratory management, personnel qualification, and operational compliance. Understanding these changes in-depth will be crucial for laboratory directors to navigate the new regulatory landscape effectively.

You know that the healthcare landscape is continually evolving, where “evolving” really means, among other things, staying informed about regulatory changes.

See Past Events: 2022 | 2021 Are you looking to stay ahead of the curve in the ever-evolving landscape of healthcare? Mark your calendars for these upcoming events and conferences in 2024. From cutting-edge technology to revenue cycle management strategies, these gatherings offer invaluable insights and networking opportunities for healthcare professionals. Here's a glimpse of what's in store:

Maintaining an efficient and compliant medical practice is crucial in the rapidly evolving healthcare industry. One key aspect often overlooked is the efficacy of medical billing software. Older systems may become obsolete, inefficient, or non-compliant with current standards as technology advances. Here are five signs indicating it's time for your practice to upgrade its medical billing software.

The Centers for Medicare & Medicaid Services (CMS) recently released its 2024 physician fee schedule final rule. Why are you thinking this will be ominous and not good for you? Perhaps that old joke about, “We’re from the government and we’re here to help,” is in your head.