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Medical Necessity: How Payers Turned Coverage Restrictions into the Moral High Ground

Medical Necessity: How Payers Turned Coverage Restrictions into the Moral High Ground

by Alex Mitchell | Aug 25, 2026 | Payer Audits & Alerts, Revenue Cycle Management, Industry Insights, Clinical Laboratory

By: Jon Harol, Founder, LLS When did an insurer’s decision not to pay for a laboratory test become evidence that the test shouldn’t be performed? Over more than two decades working in the clinical laboratory industry, I have watched the concept of “medical necessity”...
What is MolDX and When Do I Need a Z-Code?

What is MolDX and When Do I Need a Z-Code?

by Alex Mitchell | Mar 19, 2026 | Clinical Laboratory, Payer Audits & Alerts, Denial Management, Revenue Cycle Management, Industry Insights

00:00 1X   Laboratories performing infectious disease testing and billing Medicare Part B within a MolDX jurisdiction are subject to a new Local Coverage Determination (LCD) that stands to significantly impact reimbursement for these services. Labs in the...
IHC Reimbursement Under the Microscope: What Pathology Groups Need to Know

IHC Reimbursement Under the Microscope: What Pathology Groups Need to Know

by Alex Mitchell | Feb 11, 2026 | Payer Audits & Alerts, Billing & CPT Codes, Revenue Cycle Management, Industry Insights

00:00 1X   Payment and coverage for immunohistochemistry (IHC) stains are facing increased scrutiny from both commercial and government payers. For pathology groups and laboratories, this heightened attention has translated into tighter policy language, expanded...
Balancing Compliance, Risk, and Revenue in Toxicology Testing

Balancing Compliance, Risk, and Revenue in Toxicology Testing

by Alex Mitchell | Nov 11, 2025 | Payer Audits & Alerts, Denial Management, Tips for New Lab Owners, Industry Insights, Clinical Laboratory

00:00 1X   For many labs, toxicology has long been a top target for payer audits. Reimbursement cuts and stricter “medical necessity” interpretations are raising denials, claw-backs, and scrutiny, especially around frequency of testing and documentation quality....
Medical Billing Audit Unlocks $20K in Claims After Cyberattack

Medical Billing Audit Unlocks $20K in Claims After Cyberattack

by Alex Mitchell | Sep 15, 2025 | Case Studies, Payer Audits & Alerts, Denial Management, Tips for New Lab Owners, Revenue Cycle Management, Industry Insights

00:00 1X   As we look back at recent trends, 2024 may go down as the year of the cyberattack. In February of last year, the Change Healthcare breach made national headlines as the largest healthcare cyberattack in history, halting claims submission and disrupting...
6 Tips for How to Get In Network with Insurance Companies

6 Tips for How to Get In Network with Insurance Companies

by Alex Mitchell | Sep 11, 2025 | Payer Audits & Alerts, CMS Fee Schedules, Revenue Cycle Management, Industry Insights, Clinical Laboratory

00:00 1X   Has your lab or group encountered obstacles when trying to determine how to get in network with insurance companies who represent your patient population? If so, you’re not alone. Health insurance companies manage their provider networks in a...
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