Financial relationships between clinical laboratories and commercial payers have evolved into a high-stakes, technological tug-of-war. For nearly a decade, the clinical laboratory industry has wrestled with the provisions of the Protecting Access to Medicare Act (PAMA). While repeated legislative delays of PAMA-mandated cuts to lab test reimbursement rates have offered independent and hospital laboratories temporary […]
Behind the Cat-and-Mouse Game of Lab Reimbursement
Commercial payers use new denial tactics as clinical labs fight back with automation
- By Scott Wallask
- > From the Volume XXXIII, No. 7 - May 26, 2026 Issue
- Tags: AI, artificial intelligence, Centers for Medicare and Medicaid Services, CMS, executive war college, Kyle Fetter, lab intelligence, Lale, large language models, machine learning, medical necessity denials, Medicare Advantage, medicare fee schedule, Medicare Part B, PAMA, Protecting Access to Medicare Act, RCM, revenue cycle management, White, xifin
