Withdrawal of LDT Rule Provides Regulatory Clarity and Reimbursement Guidance for Laboratories
The End of an Era: FDA is Rescinding Long-Contested LDT Rule for Labs
Category: For Laboratories
Discover the latest news, trends, and best practices in revenue cycle management for lab and diagnostic providers, including coding, billing, and collections.
Withdrawal of LDT Rule Provides Regulatory Clarity and Reimbursement Guidance for Laboratories
UnitedHealth Group’s Turmoil: The Impact on Labs and Pathology Groups
Rising costs, regulatory scrutiny, and shifting payer dynamics could reshape lab and pathology practice operations and reimbursements.
From Red Flags to Readiness: How Labs Can Stay Ahead of Audit Risks
With $1.2B in improper lab payments projected, payers are ramping up audits—putting clinical labs under intense scrutiny.
Labs Under the Microscope: Staying Ready for Payer Audits
Payer audits are increasing—Medicare TPEs, UPIC probes, and commercial pre-payment reviews are putting labs under more scrutiny than ever. In this 60-minute on-demand session, learn what revenue cycle leaders need to know in 2025 to reduce audit risk, spot common triggers, and respond effectively. We share real-world audit scenarios, key questions to ask your RCM vendor, and how the right partner can help protect your billing operations.
Carelon MBM Genetic Testing Program Policy Changes Effective August 1, 2025
Carelon Medical Benefits Management (MBM) has announced updates to its Genetic Testing Program policies that will take effect on August 1, 2025. Under the new policy, the Date of Service (DOS) for genetic testing services will be defined as the sample or collection date for all lines of business, aligning with the CMS Medicare Laboratory Date of Service Policy. For archival samples—those stored for future use, analysis, or reference—the DOS will be considered the date the sample was collected or retrieved.
Providers can review the full announcement by visiting the Carelon Provider Connections page at this link. Once there, scroll to the Genetic Testing Program section and click on the article titled “Reminder: Genetic Testing Program updates coming soon.”
Laboratory providers who wish to request an exception to these policy changes may contact the Carelon MBM Genetic Testing Team by emailing DL-GeneticTestingSolution@carelon.com.
For Quadax clients, if this policy update requires a change in how service dates are handled, please consult your Quadax representative to begin planning. This may involve modifications to your billing interface with Quadax.
The Hidden Risk of a Rapid RCM Vendor Implementation
For laboratories and pathologists, a strong revenue cycle management (RCM) implementation isn’t about speed—it’s about setting up for long-term success.
Turn the Summer Slowdown into Reclaimed Revenue Potential
Why Now Is the Right Time for Labs to Reevaluate Their RCM Partner
What’s Next for LDTs? A Look Beyond the Ruling
Get the key takeaways from our expert-led webinar on the LDT final rule ruling—and why labs must stay vigilant as the story unfolds.
Beyond the LDT Ruling: Next Steps & What it Means for Your Lab
The LDT final rule was vacated on March 31. The district court judge accepted ACLA’s and AMP’s arguments that LDTs are not devices and determined that the final rule exceeded FDA’s authority. This is a huge victory for the laboratory industry, but it is not the end. What happens (or could happen) next, and what does the decision really mean for laboratories?
Overcoming Claim Denials: Effective Strategies for Prevention and Appeals Success
Claim denials are an ongoing challenge, perpetuated by the ever-changing coverage requirements imposed by insurance companies on laboratory tests. Join this insightful webinar, as we delve into the intricate philosophy behind the practice of denials from various perspectives, including those of physicians, laboratories, insurance companies, laboratory benefits managers, and patients. By examining these differing viewpoints, we can gain a comprehensive understanding of the motivations and implications of denials.
“Overcoming Claim Denials: Effective Strategies for Prevention and Appeals Success,” will present proven strategies to prevent and reduce denials, minimizing the burden on all parties. Recognizing that preventive measures may not always be feasible, or denials may be unavoidable, we explore the importance of a robust appeal process to ensure service reimbursement and patient coverage.