TAG:
Ann Lambrix
Payers Unleash AI to Dissect Outlier Billing Patterns
Diagnostic laboratories can follow every clinical guideline, employ the most talented clinical lab professionals, and provide life-saving data to patients, yet still find themselves in the crosshairs of a federal or payer audit. The culprit is …
Why Labs Must Rethink Audit Readiness in 2026
CEO SUMMARY: Doing everything right is no longer enough to ensure claims are paid. With AI-driven audits on the rise, lab leaders must ensure their organizations can prove compliance—quickly, clearly, and consistently. Based on commentary from RCM experts Ann Lambrix and…
Insurers Get Aggressive with Years-Old Audits, Searching for Lab Overpayments
This is an excerpt of a 1,971-word article in the July 26, 2021 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: Not only are health insurers looking back to find lab overpayments and funds paid erroneously, but…
Insurers Get Aggressive with Years-Old Audits
CEO SUMMARY: Not only are health insurers looking back to find overpayments and funds paid erroneously, but payers also are requiring documentation for overpayments. If clinical labs and anatomic pathology groups do not appeal such claims quickly, they may be liable for any amount i…
CURRENT ISSUE
Volume XXXIII, No. 8 – June, 2026
Congress Returns to CLIA Reform with Proposed LDT Framework, and the Newly Filed Enhancing CLIA Act seeks to modernize clinical laboratory regulations. A newly introduced federal bill could signal the next chapter in the long-running debate over how laboratory developed tests (LDTs) should be regulated in the United States.
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