At the 2026 Executive War College for Diagnostics, Clinical Laboratory, and Pathology Management conference, Today’s Clinical Lab sat down with Suzette Tidmore to briefly discuss some of the big influences on revenue cycle management (RCM) in the clinical laboratory, including artificial intelligence (AI) and where billing and coding professionals fit in among advancing technology.
Tidmore has more than 20 years of experience working in RCM. She is currently chief revenue officer for Pathology Consultants of New Mexico and is also an independent revenue cycle consultant. She authors an RCM-themed newsletter on LinkedIn called Healthcare, Clearly.
What do you think is the most misunderstood area of lab test reimbursement claims?
Tidmore: Labs forget how much power they have. Payer contracts have power, and labs have state and federal laws that they should be aware of. Payer policies themselves sometimes read differently from the way claims are processed, and people sometimes look at these denials and say, "Oh well, we lost,” or "They’re not paying us," instead of continuing to fight. One of the most misunderstood areas is that the labs do still have quite a bit of power and leverage if they know how to use it.
Many in the lab industry suspect private payers are using AI to review claims, while labs are using AI before submitting claims and to review denials. Do you see this process becoming fully automated? If so, will collaboration between payers and providers be necessary?
Tidmore: Cooperation is definitely needed, but I don’t think you’re ever going to really get that from the payers and the providers. They’re trying to achieve separate goals. AI has been interesting because we’ve seen pieces of it used in billing for over a decade. However, today’s technology is much more advanced. Labs can catch denials up front through pattern recognition, and I think these tools can be used very effectively.
But I don’t foresee AI eliminating the biller or the revenue cycle director entirely because there’s still a layer of intelligent thinking and digging involved. Even the most sophisticated technologies can’t do what maybe 10% of that work requires. So, while AI is a great tool and will make us more effective, I don’t think that it will ever replace us 100%.
More consumers are paying attention to their lab test results, especially since the pandemic. What opportunities does that present for clinical labs?
Tidmore: Labs have many opportunities to go direct to consumers. Health care is trending toward direct-to-consumer and direct-to-employer models, and labs that consider those trends will be ahead of the game. States are also starting to mandate that employers and hospital groups partner with a direct contract, so labs need to pay attention to that. Health literacy is another big factor. Labs that can be a valuable resource for patients by making lab information easier to understand are going to have a competitive advantage.
You mentioned “direct to employer.” What does that mean?
Tidmore: Some states are mandating that hospital systems give employers rates below 250% of Medicare instead of negotiating directly with insurance companies. So, direct-to-employer arrangements allow employers to make their own contracted agreements with hospital or laboratory systems. I think we’re going to see more of that approach.
Are there other technologies or innovations that you’re excited about today?
Tidmore: On the billing side, there are a lot of smart tools coming out. For instance, there’s something new that I’ve got acquainted with called Policybot. You can type in a billing code, and it will pull up everything from a payer on that code. Sourcing that type of information is going to be so much easier for lab billers, and I’m excited about that because I used to spend hours and hours reading medical policies. All of these advances are going to make billers’ jobs easier. I don’t think we should be scared of being replaced—we’re going to be more efficient.
