The 2025 Clinical Laboratory Fee Schedule (CLFS) update has given U.S. labs extra time to prepare for the upcoming January 1 – March 31, 2026, reporting period. Originally announced in 2024, this update delayed certain data
How to Modernize Your Healthcare Revenue Cycle: 3Gen Consulting’s Guide to Better Results
Healthcare organizations face constant pressure: rising medical billing denials, delayed reimbursements, evolving regulations, and overstretched staff. Outdated workflows and manual processes quietly erode revenue, create compliance risk, and add stress to your team.
For provider groups across the USA, every delayed claim or denied payment isn’t just lost revenue – it’s added operational pressure. At 3Gen Consulting, we understand these challenges. Modernizing your medical billing services, medical coding, and revenue cycle management (RCM) isn’t just a buzzword – it’s a pathway to measurable improvements in efficiency, compliance, and financial performance.
Here’s how healthcare organizations can transform their revenue cycle for better results.
Leverage Data-Driven Insights to Prevent Revenue Loss
Decisions based on assumptions or “we’ve always done it this way” thinking can quietly erode revenue. 3Gen Consulting, a leading medical billing company, helps organizations leverage analytics in revenue cycle management to spot inefficiencies, reduce denials, and improve medical billing accounts receivable.
Our data-driven approach includes:
- Analyzing claims, accounts receivable, and denial trends
- Identifying gaps in medical coding and clinical documentation workflows
- Highlighting high-risk areas like underreported services or incorrect modifiers
For more on leveraging data to prevent costly guesswork, see our blog: Data-Driven Healthcare Revenue Cycle Management: Why Guesswork Costs You Money.
Proactive Coding Audits: Stop Denials Before They Happen
Coding errors are one of the leading causes of denials in medical billing, delayed payments, and compliance headaches. Missing documentation, incorrect modifiers, and underreported services can quietly drain revenue and trigger audits.
3Gen’s coding audits help organizations catch these issues early. Our approach:
- Focuses audits on high-risk areas
- Identifies underreported services and documentation gaps
- Implements automated tools to streamline analysis and reduce manual errors
By addressing vulnerabilities before claims submission, your medical billing and coding company can minimize rework, maintain compliance, and protect revenue.
Dive deeper into auditing best practices here: Medical Coding Audits 101: How Physicians Can Stay Ahead of the Curve.
Streamline Revenue Cycle Processes with Automation
Manual workflows increase the risk of errors and slow down revenue cycle management services. AI-powered automation can transform your RCM processes. 3Gen’s suite of platforms – including RevGen-i, CodeGen-i and RiskGen-i – streamlines claims processing, coding and risk adjustment with precision.
By integrating automation, your team can:
- Accelerate claim submissions and payment posting
- Validate medical coding and documentation in real time
- Reduce medical billing denials and rework
- Track trends and generate actionable insights
Modern RCM isn’t just faster – it’s smarter, freeing staff to focus on strategic initiatives rather than repetitive tasks.
Explore our CEO’s insights on AI in RCM: AI in Healthcare Revenue Cycle: The Big Opportunity in Medical Billing Accounts Receivable.
Invest in Staff Training and Development
Even the most advanced AI tools and audit programs are only as effective as the people using them.
Continuous staff education ensures your team stays current on:
- Evolving medical coding in USA guidelines and payer rules
- Clinical documentation best practices
- Workflow optimization and automation tools
3Gen’s provider education programs upskill coders and billers to think like auditors, enabling them to prevent errors before claims are submitted. This targeted education improves compliance, reduces medical billing denials, optimizes overall medical billing and coding efficiency, and equips teams for future AI integration and evolving payer requirements.
Learn more about the impact of targeted education here: Medical Coding Audits: The Silent Guardian Against $36 Billion in Annual Compliance Risks.
Why Partner with 3Gen Consulting
Modernizing your revenue cycle management is complex, especially with limited resources and evolving regulations. As a trusted medical billing company, 3Gen Consulting helps provider groups:
- Maximize reimbursements with accurate medical coding services and medical billing services
- Reduce denials in medical billing and rework across accounts receivable
- Implement AI automation and workflow optimization for efficiency
- Ensure compliance with CMS, payer rules, and industry standards
Our integrated approach combines medical billing and coding services, AI-driven platforms, and strategic insights to strengthen financial performance and operational excellence.
Modernize Today to Safeguard Revenue Tomorrow
Revenue cycle management is dynamic. Outdated workflows cost money, slow down staff, and increase compliance risks. By adopting data-driven insights, proactive coding audits, AI automation, and staff education, healthcare organizations can anticipate issues before they arise, reduce medical billing denials, streamline accounts receivable, and protect revenue.
With a trusted partner like 3Gen Consulting, healthcare organizations can turn challenges into opportunities, modernizing their revenue cycle to achieve long-term financial stability and operational excellence.
2025 CPT PLA Code Updates Are Live: How Labs Can Stay Ahead in U.S. Billing
Effective October 1, 2025, the American Medical Association (AMA) introduced 25 new Proprietary Laboratory Analyses (PLA) codes, along with two deletions and one revision [1]. For U.S. labs and billing teams, these changes are more than just paperwork – they directly impact claims, revenue, and compliance.
With the right approach and tools like RevGen-i, labs can implement these updates efficiently, minimize errors, and safeguard revenue.
What Are PLA Codes and Why They Matter for Lab Billing
PLA codes represent specialized clinical lab tests that may be offered by a single laboratory or licensed to multiple providers. These codes cover advanced diagnostics such as oncology panels, transplant monitoring, and rare disease sequencing.
Accurate coding is crucial for U.S. labs and billing teams. Proper PLA code usage ensures claims are processed correctly, reduces denials, and helps capture full reimbursement for proprietary lab analyses.
PLA Code Updates: New, Revised, and Deleted Codes
The October 2025 AMA updates introduce several significant changes:
Deleted Codes: 0450U and 0451U, both related to multiple myeloma testing using LC-MS/MS.
Revised Code: 0333U now applies only to the HelioLiver™ Test by Helio Genomics® for liver oncology surveillance.
New Codes: 25 new PLA codes span oncology, transplant, neuro, infectious disease, and gastrointestinal diagnostics. Key additions include:
- 0575U – HepatoTrack™ Liver RT-PCR 4 Genes, LuminoDx Inc
- 0577U – GlycoKnow™ Ovarian, InterVenn Biosciences
- 0585U – Labcorp® Plasma Complete™ cfDNA Panel
- 0596U – Precivity-ApoE™, C2N Diagnostics
Labs should review the full list and ensure their U.S. lab billing services are updated to reflect these changes, verifying each code against internal testing menus and payer requirements.
Why Labs Should Act Fast on PLA Code Changes
PLA code updates are more than just administrative housekeeping – they directly impact revenue, compliance, and operational efficiency. Acting quickly ensures your lab billing services team stays ahead of potential issues.
Revenue Accuracy is critical. Submitting a claim with the wrong PLA code can lead to denials, delayed payments, or under-reimbursement.
Regulatory Compliance is another key factor. PLA codes are proprietary, and incorrect coding can trigger audits or compliance flags.
Workflow Efficiency matters too. Updating codes manually can be time-consuming and error-prone, slowing down your entire claims process.
Streamline Lab RCM with RevGen-i
Implementing PLA code updates doesn’t have to slow your lab down. RevGen-i, 3Gen Consulting’s AI-driven billing platform, acts as a smart co-pilot for U.S. lab billing services.
With RevGen-i, labs can:
- Update new, revised, and deleted PLA codes across billing workflows
- Validate test-to-code mapping to ensure claims are submitted accurately
- Track potential denials and rework tied to proprietary lab tests
- Generate real-time analytics to monitor revenue trends and reimbursement patterns
By integrating RevGen-i, labs can reduce manual errors, improve efficiency, and protect revenue – all while staying compliant with AMA coding requirements.
Takeaway: Stay Ahead in U.S. Lab Billing
The October 2025 PLA code updates are live, and labs that act proactively will benefit from smoother workflows, accurate claims, and optimized revenue. Leveraging smart tools like RevGen-i ensures that PLA code changes are implemented seamlessly, letting billing teams focus on efficiency rather than errors.
For labs looking to strengthen their lab billing services, accuracy alone isn’t enough. Proactive workflow management and AI-enabled automation are key to staying ahead in today’s evolving coding landscape.
Contact us to learn how RevGen-i can simplify PLA code updates for your lab.
References
[1] AMA, “CPT® Proprietary Laboratory Analyses (PLA) Codes: Long Descriptors,” 1 October 2025. Available: https://www.ama-assn.org/system/files/cpt-pla-codes-long.pdf.
October 2025 Newsletter
We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle management services to the challenges of USA medical billing.
Home Health Industry Threatened by Shutdown
The recent government shutdown is causing problems for the home health industry and home health care billing, pushing it over a telehealth cliff, limiting its patient pool, and adding administrative burden, according to Home Healthcare News. It’s also frozen the Acute Hospital Care at Home (AHCAH) program [1].
Risk Adjustment Audit Overhaul Struck Down
A federal judge in Texas has ruled that DHS violated the Administrative Procedure Act, failing to appropriately notify industry stakeholders and the general public about the changes in the medical coding audit rule. The suit was brought by Humana, challenging the September 2023 RADV overhaul. The ruling is being counted as a significant win for payers [2].
CMS Expects Medicare Advantage and Medicare Prescriptions Drug Programs to Remain Stable
The agency has announced that the average plan choices, premiums, and benefits for the MA program and Part D prescription drug program will be stable in 2026. Average premiums are expected to decline in both programs. CMS is releasing this information ahead of Medicare Open Enrollment [3].
Lab Developed Test Final Rule Rescinded
The FDA rescinded the final rule on laboratory developed tests. This action puts a formal end to a long-term effort to increase oversight in the industry. The agency has issued a new final rule, changing the definition of in vitro diagnostics to align with pre-2024 regulations [4]. Healthcare providers and medical billing companies should keep an eye out for changes that impact them.
HCPCS Quarterly File Updated
The previously released HCPCS quarterly update for October has been updated as of 9/23/2025. The medical billing updates can be reviewed and downloaded by the public on the CMS website under the file name: October 2025 Alpha-Numeric HCPCS File (ZIP) [5].
E/M Billing and Coding Updates Released by CMS
CMS has published a revised MLN booklet, covering E/M services. This update concerns billing and medical coding updates for home or residence services, telehealth services, hospital outpatient clinic visits, critical care services, and more [6].
The Impact of Federal Funding Cuts on Health Systems
Becker’s Hospital Review has published an overview of the impact of the One Big Beautiful Bill Act to multiple areas of healthcare including Medicaid reductions, ACA subsidies, Medicare Advantage, 340B drug pricing programs, and NIH funding [7].
New ICD-10-CM Codes Announced
CMS has announced new ICD-10-CM codes that are effective October 1, 2025 for revenue cycle management services. These codes will impact discharges from October 1, 2025 to September 30, 2026. They will also impact patient encounters between October 1, 2025 and September 30, 2026 [8].
Humana to Pay $32M in Fees in False Claims Settlement
Humana has been ordered by a federal court to pay over $32 million in fees, including attorney’s fees, costs, and interest connected with the resolution of a False Claims Act case from 2024. The lawsuit was filed in 2016 by a former actuary for Humana who claimed that the company sent CMS fraudulent bids for the Walmart Part D prescription drug plan [9].
The AHA Pursues Commitments on Prior Auth Reforms
The American Hospital Association has encouraged HHS leadership to keep the promises they’ve made on prior authorization reforms for the hospital revenue cycle. The association sent a letter to CMS and HHS leaders, emphasizing the fact that 95% of hospitals report that staff time spent on prior auth approval has increased in the last year, increasing patient frustration and burden on providers [10].
New Epic Interoperability Features
Epic has launched multiple new data-sharing features at a recent interoperability conference. They include more prior authorization APIs, MyChart changes, and updates to align with federal interoperability standards [11].
References
[1] M. Gonzales, “Government Shutdown Halts Telehealth Flexibilities, Hospital-at-Home Waiver, Threatening Home Health Industry,” Home Health Care News, 1 October 2025. Available: https://homehealthcarenews.com/2025/10/government-shutdown-halts-telehealth-flexibilities-hospital-at-home-waiver-threatening-home-health-industry/.
[2] P. Minemyer, “Federal judge strikes down 2023 risk adjustment audit overhaul in win for Medicare Advantage plans,” Fierce Healthcare, 26 September 2025. Available: https://www.fiercehealthcare.com/payers/federal-judge-strikes-down-2023-radv-audit-overhaul-win-medicare-advantage-plans.
[3] CMS, “Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2026,” 26 September 2025. Available: https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2026.
[4] S. Kelly, “FDA rescinds LDT final rule,” TechTarget, Inc., 19 September 2025. Available: https://www.medtechdive.com/news/FDA-rescinds-LDT-final-rule/760645/.
[5] CMS, “HCPCS Quarterly Update,” 23 September 2025. Available: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update.
[6] CMS, “Evaluation and Management Services,” September 2025. Available: https://www.cms.gov/files/document/mln006764-evaluation-management-services.pdf.
[7] E. Cerutti, M. Ashley, J. Emerson and E. Casolo, “What ‘federal funding cuts’ really mean for health systems,” Beckers Hospital Review, 29 September 2025. Available: https://www.beckershospitalreview.com/finance/what-federal-funding-cuts-really-mean-for-health-systems/.
[8] CMS, “ICD-10 Codes,” 1 October 2025. Available: https://www.cms.gov/medicare/coding-billing/icd-10-codes.
[9] J. Emerson, “Court orders Humana to pay $32M in fees following False Claims settlement,” Beckers Payer, 30 September 2025. Available: https://www.beckerspayer.com/legal/court-orders-humana-to-pay-32m-in-fees-following-false-claims-case/.
[10] American Hospital Association, “AHA Supports Administration Facilitating Health Insurer Pledge to Reform Prior Authorization,” 29 September 2025. Available: https://www.aha.org/lettercomment/2025-09-29-aha-supports-administration-facilitating-health-insurer-pledge-reform-prior-authorization.
[11] G. Bruce, “Epic unveils new interoperability features: 7 things to know,” Beckers Hospital Review, 25 September 2025. Available: https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/epic-unveils-new-interoperability-features-7-things-to-know/.
The ABCs of Laboratory Billing: How Pathology Groups Can Stop Losing Revenue
Running a pathology group or diagnostic laboratory is challenging enough – but revenue cycle challenges make it even harder. If your lab claims are being denied due to missing prior authorizations, incorrect CPT codes, or “medical necessity not met” errors, you’re not alone.
Laboratory billing is one of the most complex areas of U.S. healthcare revenue cycle management (RCM). With payers tightening scrutiny on molecular and genetic testing, expanding prior authorization requirements, and rolling
