Healthcare IT Blog

The regulatory landscape for clinical laboratories is rapidly evolving. With CMS increasing improper payment audits, MACs tightening enforcement, and commercial payers revising medical necessity and frequency rules, 2025 is shaping up to be one of the most compliance-intensive years ever for lab billing.

For clinical laboratories, time is money—literally. When claims take 72 hours or longer to reach the payer, the revenue cycle slows, aging AR builds, and downstream denials increase. In an environment where margins are shrinking and payers are tightening scrutiny, slow claims submission is a silent killer of cash flow.

For labs, the margin between profitability and loss often comes down to billing. Lab services are reimbursed at lower rates than ever, yet the cost of doing business keeps rising. Between complex payer rules, coding nuances, and frequent denials, it’s easy to lose thousands per month without realizing it.

At a time when labs are operating on tight margins, revenue leakage is more dangerous than ever. Clinical laboratories, particularly those specializing in pathology, toxicology, molecular diagnostics, and genetic testing, are losing 20% to 40% of total billable revenue—and often don’t even know it.

Choosing the right laboratory software isn’t just an IT decision—it’s a business-critical investment that can shape everything from daily workflow to long-term profitability. Whether you’re a clinical lab, toxicology group, pathology practice, or molecular testing facility, the wrong system slows you down, exposes you to billing errors, and limits scalability.

There are two types of drudgeries:

Artificial intelligence (AI) continues to transform the healthcare industry, with radiology, patient portals, and AI faxing seeing significant advancements in 2025.

As the demand for mental health and substance use disorders services continues to grow, behavioral health billing in general has become increasingly complex. Providers must navigate evolving regulations, new diagnostic codes, and shifting reimbursement structures to ensure accurate billing and optimal financial outcomes.

Healthcare Revenue Cycle Management (RCM) is the financial foundation of every type of healthcare organization. RCM should span the patient’s entire journey, from scheduling and eligibility verification to final payment collection, and even beyond with reminders to schedule next appointments as may be appropriate.

Today’s overall healthcare landscape – including laboratories – is driven by data, speed, and accuracy. That’s why artificial intelligence (AI) has rapidly emerged as a transformative force in laboratory billing, helping to streamline administrative tasks, improve efficiency, and optimize revenue cycle performance.