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Laboratories are heading into 2027 facing pressure from multiple directions at once. The 2026 PAMA reporting period has closed. CMS will use that data to set Clinical Laboratory Fee Schedule (CLFS) rates for 2027 through 2029, with civil monetary penalties still a live risk for labs that submitted incomplete or inaccurate data. At the same time, payer audits and documentation requests are increasing, broad testing panels are drawing heightened scrutiny, and medical necessity determinations remain one of the most heavily contested areas in laboratory billing.
This webinar takes a wide-angle look at what’s driving reimbursement risk heading into 2027 and what labs need to do about it. Danielle Tangorre will cover the legal and regulatory landscape, including how anticipated PAMA-driven rate changes may affect payer contracting and allowed amounts, the legalities of collecting payment from patients, why audits and denials tied to medical necessity are climbing, and what recent enforcement actions and qui tam cases signal for labs going forward.
Darla Wanitschke will bring the operational lens, addressing how labs can identify which specific tests carry the highest financial and audit risk, tighten documentation and workflows to withstand audits, and close the gaps that lead to avoidable revenue leakage. Labs cannot control what CMS sets the CLFS at or when a payer opens an audit, but they can control how well they document, defend, and collect what they’re owed. This session is built to help them do exactly that.
By the end of this session, attendees will be able to:
- Explain how 2026 PAMA reporting will shape 2027 CLFS rates and identify the compliance, contracting, and patient-collection issues labs need to address as those changes take effect.
- Recognize the current enforcement landscape, including why payer audits and medical necessity challenges are increasing and what recent case outcomes mean for laboratory risk exposure.
- Apply practical strategies for identifying which tests carry the highest financial and audit risk, strengthening documentation and audit readiness, and reducing revenue leakage across the laboratory revenue cycle.
