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.

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.

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.

Wound care is one of the most valuable services a podiatry practice provides, and one of the easiest to lose money on. The care is usually right. The note is what fails. A missing depth measurement, an ulcer coded like a wound, or a debridement code that doesn't match the tissue removed is enough to turn a paid claim into a denial, a downcode, or a refund request after an audit.

Your billing manager pulls the aging report on a Friday afternoon. The EMG claims from three weeks ago are still sitting there. Two EEGs came back denied for medical necessity. An infusion claim bounced because the diagnosis code didn't match the one on the authorization. None of these were clinical mistakes. Every one of them was a billing problem.

Ask five people at a practice what revenue cycle management means, and you will likely get five different answers. The front desk thinks it is insurance verification. The billing team thinks it is claims and denials. The physician thinks it is whatever happens after they finish a chart note. All of them are partially right, and that fragmented understanding is exactly why so much revenue disappears between patient visit and deposited payment.

The AMP 2026 Annual Meeting & Expo runs November 10 to 14 in Seattle, with the main program November 12 to 14. The ADS lab team will be in Booth #1901. Molecular lab leaders will spend three days on new assays, sequencing workflows and what comes next in precision diagnostics. The science gets the spotlight. The billing decides whether those tests get paid. If you are heading to Seattle, here are five questions worth bringing with you, and worth answering before your next payer audit.

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.

Molecular diagnostics continues to change what is possible in medicine. Genetic testing, next generation sequencing, biomarker testing and other advanced diagnostics are giving clinicians increasingly sophisticated information to help diagnose disease, guide treatment and support precision medicine.

Ophthalmology billing is some of the most code-dense work in medicine. One busy clinic day can mix eye exam codes, E/M visits, imaging, injections with drug codes, and surgery inside a 90-day global period, and every one of them needs the right eye, the right modifier, and documentation to back it up.