Laboratory Business Insights Newsletter

Missed Us at War College? Here’s What Matters Most

1. Revenue Problems Are Starting Earlier Than You Think

One of the most consistent themes across War College discussions:

Revenue cycle issues are no longer just billing problems.

They are starting earlier:

• At order entry
• In documentation
• In coding alignment
• In workflow inconsistencies
  
  

By the time a claim is denied, the issue is already built into the process.

2. The PAMA Reporting Window Is Now Open

The PAMA reporting period (May 1 – July 31, 2026) is officially underway, under the Centers for Medicare & Medicaid Services.

What this means for your lab:

• You must submit accurate private payer data 
• Data period: January 1, 2025 – June 30, 2025 
• Penalties can reach $10,000 per day 

What We Heard at War College

Many labs:

• Are unsure if they qualify as “Applicable Laboratories”
• Don’t fully trust their data extraction
• Are still relying on manual processes
  
  

3. Independent Labs Are Feeling the Most Pressure

For independent laboratories, the challenges are more immediate.

Without hospital backing, many are dealing with:

• Increased reporting requirements
• Payer restrictions and narrow networks
• Higher administrative costs tied to billing
  
  

Where This Is Hitting Hardest

• Limited access to referral networks
• Higher denial rates
• Difficulty managing compliance requirements
  
  

Some labs are already adjusting:

• Reevaluating test menus
• Exploring direct contracting
• Tightening operational workflows
  
  

4. Payers Are Reshaping the Market

Payers like UnitedHealthcare and Cigna continue expanding narrow networks.

This is changing:

• Who gets referrals
• How labs are reimbursed
• Which services remain viable
  
  

At the same time, prior authorization requirements are expanding—even for routine testing.

What This Means

Revenue is no longer just about volume.

It’s about:

• Access
• Compliance
• Administrative cost per test

 

5. Coding and Compliance Are Getting More Complex

2026 continues to introduce changes that are impacting labs right now:

• Growth in PLA codes
• Stricter duplicate testing rules
• Increased enforcement of molecular test requirements (via Palmetto GBA)
  
  

These changes are creating more opportunities for:

• Denials
• Delays
• Missed reimbursement

 

6. AI Is Changing Both Sides of Billing

At War College, AI wasn’t theoretical—it was operational.

Labs are using it to:

• Validate claims before submission
• Check medical necessity earlier
• Reduce manual billing work
  
  

At the same time, payers are using AI to:

• Audit claims faster
• Identify patterns
• Flag inconsistencies
  
  

What This Means

You can’t rely on fixing issues after submission anymore.

You need:

• Cleaner data upfront
• More consistent workflows
• Better visibility into billing risk

 

The Bottom Line

The message from War College was consistent:

Labs that control their processes early will control their revenue later

Those that don’t will continue to:

• Chase denials
• Absorb administrative costs
• Lose margin over time