Labs are working harder than ever and getting less for it. Volumes are rising, payments are slowing, denials are increasing, and margins are shrinking.
For example, a recent industry survey found that 41% of providers now report claim denial rates of 10% or higher, a trend that has risen each year since 2022. In addition, 54% of providers say claim errors are increasing, while 68% say submitting clean claims is more challenging than the prior year.
The gap between effort and outcome is the central frustration of the moment, and it's worth being honest about why it exists.
The problem isn't the tools. The problem is that the tools work in isolation. Eligibility, prior authorization, coding, claims submission, and denials management each do their job, but they don't communicate with one another in any meaningful way.
Revenue leaks live in those handoffs, and no amount of point-solution automation can close gaps it cannot see. What labs actually need is end-to-end visibility across the revenue cycle.
Fragmentation is the real cost center
When automation is layered onto disconnected workflows, it doesn't fix them. It just amplifies mistakes. Clean claim rates decline, and staff spend their days reconciling data across systems rather than processing claims. The dashboards look busy, but the underlying coordination problem remains untouched.
Meanwhile, payers are modernizing to their benefit at a rate most labs can’t keep up with. They're using AI to scrutinize claims, pull codes, and demand documentation in real time, and their rules change constantly. Soft denials, downcoded payments, partial reimbursements, and requests for additional information quietly erode revenue without ever registering as denials in the data.
Coding adds another layer of risk. The same procedure can require different CPT codes depending on the payer or panel, and getting it wrong is common. Catching it before the claim goes out is where the savings live. Labs that rely on monthly reports are always a step behind. By the time a denial pattern surfaces on a dashboard, the revenue is already gone or delayed.
Coordination, not more tools
The fix isn't another platform—it's connecting what labs already have so the pieces operate as one system.
Here’s how to improve coordination:
1. Link the workflows
Eligibility, authorization, coding, and submission should share data as it enters the system, not in overnight batches. Real-time information flow is what turns isolated automation into orchestration.
2. Catch problems at intake
Flag risky claims before they go out, not after they come back denied. Front-end intelligence prevents far more revenue loss than back-end appeals ever recover.
3. Track the right things
Denial rate alone misses the picture. Add denial prevention, one-touch resolution, underpayment capture, and cost-to-collect to see where margin is actually moving.
A connected system
Revenue cycle management (RCM) is where margins live or die. Labs that treat RCM as a connected system will collect faster, navigate payer complexity with fewer surprises, and absorb rising volume without piling on staff. The ones that keep stacking disconnected tools will keep watching revenue slip through the seams.
The good news is that this shift is well within reach. The technology, data, and operational knowledge already exist inside most labs. Lab leaders who choose coordination over accumulation will build a revenue cycle that finally works at the speed their science deserves.
