In a decisive move, the American Clinical Laboratory Association (ACLA) is attempting to rally the lab community and stakeholders across the nation while taking on Congress by creating a new campaign called the “Stop Lab Cuts campaign.” The campaign is an effort to safeguard patient access to laboratory services through an advocacy effort to pass the Saving Access to Laboratory Services Act (S. 4449/H.R. 8188) by the end of the year. With proposed policies over the years aiming to strike and weaken reimbursement, staffing levels impacted by the great resignation, and the general financial turmoil created by a global pandemic, the value of protecting dwindling reimbursement is imperative.
As you may know, Medicare payment cuts are likely coming at the start of next year. By cutting reimbursement, access to diagnostic tests could be put at risk. However, according to the ACLA, there are even more consequences at stake stating “After three prior rounds of 10 percent cuts, additional reductions to payments may result in a weakened clinical lab infrastructure, making it more difficult to deliver routine health care and respond to the next public health crisis. Without strong clinical laboratories, the nation’s response to COVID-19 would have been severely hampered.”
According to the ACLA, over 800 tests across the nation are slated to experience an up to 15 percent reimbursement cut at the start of the next year. However, this is the shadow of “previous rounds of cuts between 2017 and 2022 that resulted in payment for tests used to screen and diagnose diabetes, heart disease, and other chronic conditions to be cut by 27 percent. Some tests could see a cumulative cut of up to 41 percent.”
Furthermore, reimbursement cuts stifle investment in future generations of diagnostic tests.
The bipartisan and bicameral legislation plans to adjust the existing 2014 Protecting Access to Medicare Act (PAMA). As many may know the PAMA Act, has resulted in “significant cuts to Medicare payments for routine laboratory tests that guide clinical decision-making.” By building a robust clinical laboratory infrastructure, healthcare will be able to reinforce the execution of everyday patient care. This structure, if properly maintained, can provide protection against the inevitable future public health crisis. The Saving Access to Laboratory Service Act would support existing needs while creating innovation for future generations of clinical diagnostics.
In an online press release, Susan Van Meter, ACLA President, commented that “Without congressional intervention this year, laboratories across the country will face a fourth round of Medicare reimbursement cuts, which could threaten the delivery of routine care, undermine the clinical laboratory infrastructure needed to manage multiple public health challenges, and reduce investment in innovation, Congress has acted three times to delay these harmful reimbursement cuts, but long-term reform is needed to safeguard access to the essential tests that patients need.”
The act was put forward early this summer in June by senators Sherrod Brown (D-OH) and Richard Burr (R-NC), along with Reps. Bill Pascrell (D-NJ), Scott Peters (D-CA), Richard Hudson (R-NC), Gus Bilirakis (R-FL), and Kurt Schrader (D-OR). The act would break down the data reporting and offer a simplified process. Policies within the act guide the Centers for Medicare & Medicaid Services (CMS) to gather data from a statistical sampling of not just a few types of labs but all significant types of labs including hospital, independent, and physician office laboratories.
The ACLA praised the potential policy, stating “Targeted sampling, as designed by the Saving Access to Laboratory Services Act, is a straightforward solution to collecting representative private market data to achieve accurate and sustainable Medicare rates for laboratory services. In the long-term, sustainability for lab reimbursement will support strong clinical laboratory infrastructure to protect public health and innovation in tomorrow’s diagnostics while providing robust access to improve patient health.”
To explore more coding and compliance topics subscribe to our Laboratory Compliance Manager Newsletter. The Laboratory Compliance Manager Newsletter is your monthly gateway to the latest laboratory-specific compliance, coding, and reimbursement news including topics like the clinical laboratory fee schedule, coding changes, the final rules, CLIA-waived tests, PLA code releases, and more. Subscribe today!
Information Source:
https://stoplabcuts.org/
In the first three parts of this series, we explored how payers analyze claims data, identify cases for additional scrutiny, and interpret the medical record
Each year, Health Information Professionals Week gives us a meaningful opportunity to pause and recognize the vital role you play in healthcare. Your work often
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
