Emerging U.S. Regulatory and Payer Trends in Laboratory Revenue Cycle Management image

Emerging U.S. Regulatory and Payer Trends in Laboratory Revenue Cycle Management

U.S. clinical labs face mounting regulatory challenges and shifting payer dynamics that are fundamentally changing how laboratory revenue cycle management (RCM) must be handled. Staying ahead means mastering compliance, optimizing payor contracting, and modernizing medical billing for laboratories to protect revenue and reduce expensive denials. If you manage a clinical lab, you’ve likely experienced how yesterday’s billing strategies no longer deliver. To survive – and thrive – you need to rethink your approach.

Regulatory Trends Shaping Laboratory Revenue Cycle Management

The regulatory spotlight on clinical laboratories in the U.S. is intensifying. The Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), and new federal mandates have made lab RCM

CLIA New Waived Laboratory Tests

Clinical Laboratory Improvement Amendments (CLIA) regulations require a facility to be appropriately certified for each test they do. CMS edits laboratory claims at the CLIA certificate level to make sure that Medicare and Medicaid only pay for laboratory tests in a facility with a valid, current CLIA certificate.

Accounts Receivable Management Tips for Healthcare: It’s Time to Standardize Your Metrics for Denial Management

Accounts Receivable Management Tips for Healthcare: It’s Time to Standardize Your Metrics for Denial Management

Claim denial rates are still a major concern for accounts receivable management in 2022. For example, denial rates for marketplace payers have reached rates as high as 80% according to the Kaiser Family Foundation [1]. But this is only the beginning. COVID has put upward pressure on denial rates for a while now. All of this means that revenue cycle leaders should be taking a fresh look at their denial management practices, not only considering accounts receivable management services but also seeing this as an opportunity to investigate new and more effective approaches to denial management.

Reduce Days in A/R

How to Reduce Days in A/R

Days in accounts receivable (A/R) is a critical number for providers to track. As healthcare revenue cycle challenges become more complex, you will need to monitor this KPI to stay competitive, keep up with consumerization trends, and support your overall financial goals. As you make this consideration, you might consider working with some of the top medical billing companies in the USA, but first, we want to help you gain some critical insights.

Get In Touch!
close slider

    Get In Touch!