October 2025

                                                          

 

LAByrinth

 

Billing, Operational, and Staffing News for Laboratories 

Presented by ADSRCM and ADS, Leading Providers of Outsourced Billing Service/Staffing or In-Laboratory            Revenue Cycle Management Systems

 

 

jim labyrinth

Message From Jim:

Immunization Schedule Update

The CDC has updated its adult and child immunization schedules, applying individual-based decision-making to COVID-19 vaccinations and recommendations. Specifically, toddlers are now recommended to receive protection from varicella (chickenpox) as a standalone immunization, rather than in combination with measles, mumps, and rubella vaccination.

These recommendations by the CDC Advisory Committee on Immunization Practices (ACIP) were approved earlier in the month (October) by Acting Director of the CDC and Deputy Secretary of Health and Human Services, Jim O'Neill (my namesake, but not a relative).

By the time you read this, the schedules will have already been updated on CDC.gov.

The recommendation emphasized that the risk-benefit of vaccination in individuals under age 65 is most favorable for those who are at an increased risk for severe COVID-19 and lowest for individuals who are not at an increased risk, according to the CDC list of COVID-19 risk factors. The FDA has approved marketing authorization for COVID-19 vaccines for individuals who have one or more of these risk factors, as well as for individuals age 65 and older.

Regarding individual-based decision-making, the CDC's immunization recommendations incorporate input from healthcare providers, including physicians, nurses, and pharmacists. It means that the clinical decision to vaccinate should be based on patient characteristics that, unlike age, are difficult to incorporate into recommendations.

Click here for details from the CDC’s newsroom.

jim labyrinth

AMP Conference Note:

Attending the November AMP conference in Boston?

Please visit us at booth 946!

Exhibitor CUSTOMIZABLE (3)

Not Becoming a Manager is a Thing

According to LinkedIn’s latest Workforce Confidence Index survey, only 30% of survey respondents spanning all industries want to become managers over the next few years. Healthcare is among the highest with staff not aspiring to be managers.

Your laboratory might be having a hard enough time already with recruiting and retaining medical and administrative staff, let alone identifying those who are both qualified to be managers/supervisors and who want to step into those roles.

This new quirk of preferring not to be a manager may pose a significant challenge for laboratory management in the future.

Click here for the LinkedIn survey.

 

(We can’t help you identify potential managers, but we can help you consolidate your in-laboratory staffing issues with ADSRCM’s behind-the-scenes outsourced workforce of laboratory billing and workflow specialists! Offload a myriad of time-consuming hands-on tasks such as claims, denial management, eligibilities, prior authorizations, claim tracking, EOB reconciliations, patient balances, and more, including how your patients call us when they have statement questions!)

The Interoperability Gap: Why Diagnostic Labs Are Still Struggling to Connect with Referring Providers

In an industry where precision and speed define both patient outcomes and business success, diagnostic laboratories continue to face a persistent and costly challenge: interoperability.

Despite decades of effort and billions of dollars invested in health IT, the data exchange between referring providers and independent clinical diagnostic labs remains fragmented, inefficient, and prone to errors.

The problem isn’t simply technical; it’s structural. Labs sit at the crossroads of care yet often lack direct integration with the myriad electronic health record (EHR) systems used by providers. Each provider relationship may require custom connectivity, unique interfaces, and manual processes that strain both operations and margins. For lab executives, this friction is more than an inconvenience; it’s a strategic threat.

The Complexity of Modern Referrals   Every lab knows the pain points:

  • Inbound test orders arrive via fax or even printed requisitions.
  • Patient demographics are incomplete or inconsistent.
  • ICD-10® codes are missing.
  • Insurance data is wrong or outdated.

The result: staff spend hours reconciling mismatched information or searching for missing data before a single specimen is processed. Alternatively, due to turnaround time pressure, they may process the specimen without the requisite data to prove clinical necessity and get paid for doing so.

On the provider side, clinicians are equally frustrated. Ordering tests via portal, fax, and paper:

  • Interrupts patient care
  • Introduces transcription risk
  • Takes a burdensome amount of staff time and delays results

The result: many physicians simply avoid using labs that make ordering too cumbersome, resulting in lost revenue for labs and reduced patient choice.

The Patchwork of Integration Efforts

Over the years, labs have tried to fix interoperability through traditional HL7s, building beautiful portals, and trying to OCR faxes.

While HL7s are part of the toolkit that solves this problem and which may work for large hospital networks and high-volume referrers, they often fail to generate ROI for independent labs and smaller practices who may be using dozens of different EHRs. Each integration is complex, costly, and slow to deploy, creating frustration rather than collaboration in the relationship between the referrer and the lab.

Moreover, compliance and security requirements have grown stricter. Data must be exchanged safely, accurately, and transparently. Many smaller labs simply lack the IT infrastructure or bandwidth to manage hundreds of secure interfaces, version updates, and vendor certifications.

So far, the industry’s answer to this is for EHR vendors to provide marketplaces and application program interfaces (APIs), which place the burden and cost of integration and API maintenance on the backs of independent labs. One EHR vendor proudly advertises that they host more than 50 APIs!

This creates a paradox: the more digital the healthcare ecosystem becomes, the harder it can be for independent labs to stay connected.

The Business Impact

Operational inefficiency directly erodes profitability. Manual data entry and order reconciliation inflate labor costs, increase turnaround times, and heighten the risk of denied claims. When orders are incomplete or mismatched, billing delays and write-offs multiply.

From a customer experience perspective, poor interoperability diminishes provider satisfaction and loyalty. Referring physicians want the same seamless experience they get from major reference labs, but independents often can’t deliver it without draining their IT budgets. As a result, many labs lose business not because of quality or pricing, but because of workflow friction.

The Strategic Imperative

For today’s lab executive, solving interoperability is no longer optional, it’s existential. The future of diagnostics is driven by data liquidity . The ability to move, interpret, and act on information instantly and securely is critical. Labs that master this capability will position themselves as indispensable partners in care coordination and value-based medicine. Those that don’t risk being sidelined by larger networks with deeper integration capabilities.

The good news is that innovation in interoperability has finally reached a tipping point. Cloud-native technologies and secure automation frameworks  are replacing the need for one-off interfaces. So, rather than building custom connections, labs can now use browser-based tools that connect securely to any provider’s EHR in real time, without requiring technical integration or data storage.

These solutions work within the clinician’s existing workflow, preserving compliance while eliminating manual re-entry and reducing onboarding time from months to minutes. For the lab, they deliver instant connectivity across provider networks, cleaner orders, faster reimbursements, and better experiences for everyone involved.

Looking Ahead

The labs that will thrive over the next decade are those that prioritize interoperability and treat it not as an IT burden, but as a growth engine. By embracing technologies that allow secure, real-time exchange of orders and results without the heavy lift of traditional integration they can reclaim control over their workflows, reduce operational drag, and build stronger, more scalable provider relationships.

The interoperability challenge has long been viewed as an unavoidable cost of doing business in healthcare. But it doesn’t have to be. A new model of digital connectivity is emerging, one that empowers labs to integrate instantly, securely, and compliantly with the providers they serve.

For forward-thinking lab leaders, the question is no longer if this transformation will happen, but how quickly they’ll move to lead it.

 

Article contributed by Becca Gordon, VP Sales and Marketing, Shadowbox

(323) 596-0999  |  becca.gordon@shadowbox.com  |  shadowbox.com

RESULTS Act Looking Good, Somewhat

As of this writing, the new PAMA reform bill (RESULTS Act: H.R. 5269/S. 2761) now has the support of 22 members of the House and two Senators.

Not insignificantly, nine of those 22 supporters are members of the House Committee on Energy and Commerce, one of the most powerful committees in Congress. In addition, the Congressional Budget Office (CBO) is seeing about scoring the bill; a CBO score is a necessary step to move a bill forward.

Still, the RESULTS Act faces an uphill battle, which is unfortunate since it could provide a rate hike to many routine tests on the Medicare Clinical Laboratory Fee Schedule (CLFS).

On that, you’re encouraged to contact your representatives in DC and urge them to support passage of RESULTS.

Click here for more about the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, as presented by ASCP.

Three Great Abbreviations for Labs: FDA OKs LDTs

Yay! The FDA rescinded its final rule on laboratory-developed tests (LDTs), bringing to an end a decades-long effort to expand oversight of the laboratory industry.

The FDA issued a new final rule that changes the definition of “in vitro diagnostics” back to what was in its regulations before the 2024 rule was enacted.

A federal district court order in March vacated the controversial 2024 rule after lab industry groups sued to stop its implementation. And, the FDA declined to appeal the district court’s ruling.

LDTs are currently regulated by CMS under the CLIA, with the FDA having enforcement discretion. The FDA estimated the LDT rule would’ve cost between $1.29 billion and $1.37 billion annually over 20 years.

Click here for details as presented by MedtechDive.

We hope you enjoyed the read!

 

Contact us about outsourced billing/staffing services (ADSRCM), or about MedicsPremier as an in-laboratory platform from ADS. We’ll help drive revenue and productivity in ways that work best for you. 800-899-4237, Ext. 2264 or info@adsc.com.

 

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Next Up:

 

Next Up: November, with new articles and items of interest for laboratories!

 

 

 

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We strive to provide our newsletters with news of the current month, not the previous month. We greatly appreciate your feedback or comments on our newsletters/content. Please opine by emailing marc.klar@adsc.com or by calling me at 973-931-7516. We’d love to hear from you!

Marc E. Klar, Vice President, Marketing, ADSRCM.

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Disclaimer: Articles and content about governmental information, such as CMS, Medicare, and Medicaid, are presented according to our best understanding. Please visit www.cms.gov for any necessary clarifications are needed. We are not responsible for typographical errors or changes that may have occurred after this newsletter was produced. Visit www.adsc.com to view our most up-to-date information. We don’t endorse any companies or organizations mentioned in our newsletters; you are encouraged to do research and due diligence on any that might interest you.

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