A Message from Jim:
For the past few months, many laboratory leaders were focused on one date: July 31. Your team gathered private payer data, met the PAMA reporting deadline and checked a major regulatory requirement off the list.
Now the real work begins.
The laboratories that enter 2027 in the strongest position will not only be watching CMS, Congress or the RESULTS Act. They will be looking inside their own revenue cycle and asking where money is already getting stuck.
That means reviewing denials, underpayments, claims that were never submitted, payer patterns, A/R, medical necessity issues and the workflows that create rework month after month.
Across molecular diagnostics, pathology, toxicology, genetic testing, clinical laboratories and complex NGS billing, the same principle applies. Revenue performance now depends on what happens before the claim ever reaches the payer.
This month, we are focusing on practical preparation: what labs can fix now before the 2027 reimbursement environment arrives.
What We Are Watching
PAMA after July 31: The 2026 private payer reporting period has closed. CMS will use the submitted information to help establish CLFS payment rates for 2027 through 2029. See CMS CLFS guidance.
RESULTS Act momentum: Laboratory organizations continue supporting reform, but the legislation has not become law. Review current bill language at Congress.gov.
Revenue leakage: The most immediate financial opportunity may be hidden in denials, underpayments, unsubmitted claims and preventable rework.
Specialty billing pressure: Molecular, pathology, genetic and NGS laboratories need workflows that reflect payer rules, authorization requirements, documentation and coding complexity.
Start with your own numbers
Before 2027 arrives, identify where your laboratory may have billing, compliance or reimbursement vulnerabilities.
Access the Free 2026 Lab Billing Compliance and Revenue Scorecard →
PAMA Reporting Is Over: What Independent Labs Should Fix Before 2027
The July 31 reporting deadline is behind us, but independent laboratories still need to prepare for 2027. This article explains why September is the right month to review revenue leakage, underpayments, A/R, payer performance and claims that never reached the payer.
Stop Working the Same Denials Twice: A Smarter RCM Strategy for Independent Labs
If the same denial reason keeps appearing every month, the problem is not only the claim. It is the workflow. This article looks at eligibility verification, medical necessity checks, standardized appeals, automation and LIS integration as tools for reducing preventable rework.
Three Things I Would Review Before Q4
- Denied dollars by payer, not just denial count
- Claims completed by the lab but never submitted to the payer
- Underpayments where the payer paid something but less than expected
If those three areas are not being measured, the laboratory may be missing revenue it already earned.
How ADS Helps Laboratories Strengthen Revenue Cycle Readiness
ADS and ADSRCM support clinical, toxicology, pathology, genetic, molecular and NGS laboratories with billing software, RCM services, eligibility verification, prior authorization options, denial prevention alerts, EOB reconciliation, claim tracking, analytics and integration with virtually any LIS or LIMS. Learn more on the ADS Laboratory Billing Services and Software page.
Ready to strengthen your lab revenue cycle?
Schedule a conversation with an ADS laboratory specialist or start with the free Scorecard. Bring your biggest issue, denials, slow collections, molecular billing, pathology claims, payer rules, A/R or disconnected systems.
Book a Meeting With an ADS Lab Billing Expert
Until Next Month
CMS is expected to release proposed CY 2027 lab payment determinations in September. We will continue watching those updates and what they mean for independent laboratories. In the meantime, the most valuable work may be the work already inside your own billing operation.
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