What Challenges Are Laboratories Facing in Revenue Cycle Management in 2026?

Laboratory revenue cycle management has never been simple — but in 2026, it has become structurally harder.

Labs are operating in an environment defined by reimbursement volatility, tighter payer scrutiny, staffing shortages, and escalating compliance demands. The result is a growing gap between the work labs perform and the revenue they successfully collect.

This article breaks down the most pressing RCM challenges laboratories face in 2026, why they are worsening, and what lab leaders should understand before these pressures turn into permanent revenue loss.

RevenueLeakage Is Accelerating Across the Lab Industry

According to Medical Group Management Association (MGMA), healthcare organizations lose an estimated 3–5% of net revenue annually to preventable revenue cycle issues — including denials, underpayments, delayed claims, and documentation gaps.

In the lab environment, that leakage is often magnified due to:

• High claim volume
• Complex payer rules
• Documentation-driven reimbursement
• Narrow margins under CLFS

Publications such as Dark Daily and College of American Pathologists have consistently highlighted medical necessity documentation and payer edits as leading causes of lost lab revenue.

PAMA and CLFS Uncertainty Continue to Pressure Margins

Although legislative delays have provided short-term relief, PAMA-related CLFS rate instability remains unresolved. Labs are still navigating:

• Shifting reporting requirements
• Multi-year reimbursement impact from a single reporting cycle
• Limited ability to offset cuts through volume
  
  

For lab leaders, the operational takeaway is clear:
When reimbursement is unstable, inefficiencies and errors become far more costly.

Recommended resource:
Use the ADS PAMA Readiness Checklist to understand where reporting gaps and revenue exposure may exist.

Denials Are Increasing — Even for “Clean” Claims

Labs across molecular, pathology, and toxicology testing report double-digit increases in denial rates, driven by:

• Tighter payer edits
• More aggressive documentation requests
• Increased scrutiny of ordering patterns
  
  

Industry coverage from American Association for Clinical Chemistry (AACC) and Association for Molecular Pathology (AMP) shows that medical necessity support — not coding accuracy — is now the most common failure point.

This shift makes traditional “submit and fix later” billing models far less effective.

Staffing Constraints Are Limiting RCM Performance

Laboratories continue to face:

• Ongoing labor shortages
• Rising wages for specialized billers
• Increased training demands tied to payer and code updates
  
  

In many labs, billing teams are forced to prioritize throughput over prevention — increasing downstream denials and write-offs.

This staffing reality has become one of the largest structural risks to lab revenue stability in 2026.

Compliance Expectations Are Expanding, Not Stabilizing

Regulatory pressure is no longer limited to audits. Payers now incorporate compliance logic directly into claims adjudication.

That means:

• More front-end documentation requirements
• Greater scrutiny of utilization patterns
• Increased exposure to payment delays even for compliant labs
  
  

As Centers for Medicare & Medicaid Services (CMS) guidance evolves, labs must ensure their billing workflows align with both reimbursement and compliance expectations — not just one or the other.

What This Means for Labs in 2026

The labs that protect revenue this year will:

• Reduce preventable leakage
• Improve documentation consistency
• Gain visibility into payer behavior
• Treat RCM as a system — not a department

 
👉 Learn how ADS supports laboratories nationwide with end-to-end revenue cycle management:

Laboratory RCM challenges in 2026 are not temporary disruptions — they are structural shifts.

Understanding these challenges is the first step toward building a billing and compliance model that can perform under pressure, not just react to it.