Accuracy gets all the attention in risk adjustment coding, and rightly so. It’s the backbone of compliance, reimbursement, and audit defense.
But here’s the truth: accuracy alone doesn’t keep your revenue cycle moving – productivity does.
That’s where many healthcare organizations and risk adjustment coding
The home health revenue cycle has experienced ongoing changes in recent years, and this year is no different. The Centers for Medicare & Medicaid Services (CMS) has announced more changes to nursing home staffing requirements, opening up opportunities for leadership to make strategic adjustments. These adjustments create downstream impacts on home health billing and home health
Oversight in the lab industry has just taken a major blow from the FDA – and every laboratory needs to rethink its revenue cycle strategy.
Earlier this year, the FDA rescinded its 2024 rule that would have treated laboratory developed tests (LDTs) as in vitro diagnostics (IVDs) and medical devices. The final rule, published in May 2024, sought to expand the FDA’s authority over LDTs. But following a federal court decision in March 2025 that vacated the rule, the agency officially reverted to the pre-2024 framework in September 2025.
In short: LDTs developed and used within a single laboratory are once again governed primarily under CLIA and CMS oversight, not full FDA medical device regulation.
That reversal – while creating short-term uncertainty – also opens new doors for innovation and growth.
This back and forth has created disruption in laboratory revenue cycle management (lab RCM), but it’s also created a new strategic opportunity. Deregulation opens the door for innovation and new partnerships – healthcare leadership now has the opportunity to bring their communities better-tailored and more forward-thinking solutions.
At the same time, the reimbursement and lab billing question is always at play. Every new or modified test still needs a sustainable billing pathway, and payers are likely to remain cautious about coverage and clinical validity, even without the FDA rule in place. Now is the time for lab leaders to reassess their offerings from a revenue cycle perspective:
One of the biggest near-term challenges in lab RCM will be staffing. Pathology and laboratory billing teams must be fluent in CPT and HCPCS code sets, especially molecular pathology and genetic testing codes that are frequently audited.
Billers must understand when tests, equipment, and even specimen transport services are billable, and how those codes interact across payers. That level of precision requires both training and data-driven oversight.
Modern laboratories are now pairing internal expertise with external vendors that specialize in laboratory revenue cycle management to fill these gaps quickly.
Revenue cycle departments will need a solid and granular understanding of the historical impact of different lab products. This regulatory reversal doesn’t remove payer scrutiny – it shifts it. Payers are expected to step up their own review of laboratory claims, particularly LDTs with limited published validation data.
To stay ahead, successful labs are:
These actions help laboratories maintain financial stability while exploring new testing opportunities.
Any policy change at this level can feel disruptive. But in our experience, it’s also a chance to modernize.
At 3Gen Consulting, we’ve seen laboratories turn regulatory uncertainty into operational clarity, by synthesizing both internal knowledge and external RCM expertise from vendors. This synergy allows leaders to not only survive but thrive in times of change by innovating confidently while keeping reimbursement predictable.
If you’d like to learn more about how your lab can strengthen its laboratory revenue cycle management framework in this new regulatory era, feel free to contact me here or connect with one of our experienced team members.
Hemant Apte, Chief Executive Officer in
Hemant Apte, Founder & Chief Executive Officer of 3Gen Consulting, is a seasoned executive leader with deep domain expertise in US healthcare management practices. He founded 3Gen Consulting in 2006 and has been instrumental in offering thought leadership to his clients and providing services and solutions that are unique in the market.
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
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.
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:
For more on leveraging data to prevent costly guesswork, see our blog: Data-Driven Healthcare Revenue Cycle Management: Why Guesswork Costs You Money.
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:
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.
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:
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.
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:
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.
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:
Our integrated approach combines medical billing and coding services, AI-driven platforms, and strategic insights to strengthen financial performance and operational excellence.
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.
