WE’RE NOT THE ONLY ONES TALKING ABOUT THE DOCUMENTATION PROBLEM.
Don’t just take our word for it. Here are some articles from around the industry and some we wrote with our partners.
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Don’t just take our word for it. Here are some articles from around the industry and some we wrote with our partners.
Prior authorization has officially outgrown its original PR story. It’s no longer a “medical necessity safeguard.” It’s a cost-control system that increasingly evaluates documentation through automated models before a human ever lays eyes on the chart.
In a tight-margin industry like toxicology and molecular diagnostics, denials, underpayments and clawbacks aren’t just annoyances—they’re threats to sustainability.
Generative AI predicts language, not truth. In healthcare, that’s not innovation. That’s legal exposure, audit risk, and even patient harm.
Labs are built on expertise, but expertise alone won’t overcome the mounting administrative and compliance burdens in today’s healthcare environment. By leveraging Shadowbox and Cellarian together, reference labs can transform operational efficiency, reduce risk, and deliver a superior client experience—turning hidden inefficiencies into a strategic advantage.
The Cellarian + Validity Diagnostics alliance is more than just a partnership—it’s a strategic model for the future of compliant, quality-driven care. By aligning intelligent documentation with precise lab diagnostics, healthcare organizations can finally close the gap between clinical intent and operational execution.
“Does it matter that the medical necessity documentation doesn’t look like it came from the EHR?”
“If medical necessity letters are formatted similarly, might this raise red flags with auditors?"
Dr. Michael Sprintz has the answers.
At Cellarian, we’ve witnessed firsthand how labs are losing up to 40% of potential income simply because medical necessity documentation isn’t handled properly. That's huge. And obnoxiously unfair.
The days of simple lab orders are long over. Increasingly, payors are demanding prior authorizations for tests that were once routinely reimbursed. We explore why labs are facing the need for more prior authorizations—and what labs can do about it.
It’s no secret—2025 is a tough year for toxicology labs. Reimbursements are shrinking, audits are increasing, and payers are denying claims at record rates. So, the big question on every lab owner's mind is: Are toxicology labs still profitable?
In today's healthcare environment, toxicology labs play a critical role — but many are unknowingly leaving up to 40% of their revenue on the table. Cellarian can help you stop the bleeding…
Many labs face significant challenges in securing reimbursement for their services. Understanding the reasons behind these reimbursement issues is crucial for laboratories aiming to navigate the complex healthcare billing landscape effectively.
Entrepreneur expert Mark Cleveland jumped into the deep end with our CEO, Dr. Michael Sprintz, on Cellarian, the origin stories, and the future of automated medical necessity documentation.
"Even when you go through this laborious process of getting [claims] appealed, we actually win most of them, which tells you there's something wrong with the system."
Prior authorization requirements are intended to ensure that health care services are medically necessary by requiring approval before a service or other benefit will be covered. Medicare Advantage insurers typically use prior authorization, along with other tools, such as provider networks, to manage utilization and lower costs.
When patient care or treatment is warranted by a specific diagnosis, I wish insurers would just reimburse it without any hassle. That's not reality. Let's talk about insurance claim denials, how they're rising and harming patient care, and what we can do about it. That's kind of complicated.
Hospitals have experienced significant increases in insurance claim and prior authorization denials since 2019, potentially driven by insurers' use of AI tools for coverage decisions, according to a report by this Senate subcommittee.
It's hard to nail down exactly when insurance companies began implementing AI tools; they tend to be vague about internal automation processes. But multiple health care and tech leaders who spoke with Newsweek began noticing accelerated claims denials between 2019 and 2020.
A recent publication from Palmetto GBA highlights the fact that laboratory services are among the top service types found to make the highest number of billing errors.
Health insurance companies claim prior authorization saves money, but this time-wasting, care delaying tactic may actually add significant costs to the nation’s health system.
Financial challenges remain a significant concern, with 81% of leaders noting a direct impact on patients, Philips' report reveals.
From beckershospitalreview.com: Researchers at the Icahn School of Medicine at New York City-based Mount Sinai found that large language models were poor medical coders.
From Laboratory Economics: As part of a new 2023 directive, CMS is asking Medicare Administrative Contractors (MACs) to focus payment audits and claim reviews on providers and labs performing definitive drug testing.
Physicians who misuse the "copy-and-paste" feature in patients' electronic health records (EHRs) can face serious consequences, including lost hospital privileges, fines, and malpractice lawsuits.
In the digital age of healthcare, Electronic Health Records (EHRs) have revolutionized the way medical professionals manage patient information. However, amid the myriad benefits, there lurks a practice that has increasingly raised concerns: copy and paste.
Prior authorization policies enacted by many payers are increasingly moving beyond limited efforts to ensure appropriate utilization of testing and instead are being applied more broadly, often blocking or delaying access to necessary care.
Did you know that Changes to Payer Guidelines are always working against your POL or Reference Lab? Changes to payer guidelines can indeed create challenges for doctors when it comes to documenting medical necessity.