What is Changing for Labs and How to Stay Ready: A Look at the RESULTS Act
Without proactive preparation, a sudden and steep revenue drop could push already thin-margin labs to their breaking point. For billing teams, this translates into longer hours, tighter cash flow, and mounting pressure just to keep operations afloat.
Key Takeaways
Inside, you will learn about:
What is changing for labs?
According to CMS, 2027 begins a three-year period where rates can drop by up to 15% annually. The actual cut for each lab will depend on its specific private-payer rates, but the maximum hit over three years could be severe.
“There’s no phase-in reduction in 2026. Beginning January 1, 2027 – 2029, payment may not be reduced by more than 15% per year compared to the payment amount established for a test the preceding year.”
By 2029, the rate is nearly 39% lower than in 2026 because each year’s cut is applied to an already-lower base. In addition, the 2026 data reporting period ended on July 31, 2026, which has been proven challenging for many laboratories because they had to:
How are labs affected by these changes?
Susan Van Meter, president of the American Clinical Laboratory Association (ACLA), said in an article, “Those are deep reductions that are unsustainable.”
For laboratories, this unsustainability means financial instability, straining the nation’s clinical testing infrastructure and threatening timely access to care for Medicare patients. CMS would have relied on outdated, 7-year-old commercial market data to set next year’s Medicare rates (ACLA, 2026). The revised CLFS payment methodology has already produced more than $4 billion in cumulative Medicare laboratory-payment reductions, according to ASCP.
More claim denials.
How can RESULTS Act help?
“When the initial PAMA cuts were deeper than they should have been because they were based on so little data and principally data from large independent labs, you drove Medicare rates down lower than they should have been,” Van Meter said. “That has implications for commercial rates.”
The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, then, would help to limit annual Medicare laboratory payment reductions to 5% beginning in 2029. It would also overhaul how the Centers for Medicare and Medicaid Services sets reimbursement rates by replacing much of the laboratory self-reporting system established under the Protecting Access to Medicare Act (PAMA) with data from a qualified independent nationwide claims database containing more than 50 billion private insurance claims.
AHA supports, “Because of the serious implications for patients who rely on both routine and advanced diagnostic laboratory services, Congress has acted to delay payment cuts for the last five years in a row and to delay data reporting for the last six years. We are grateful for that relief. Now is the time for the permanent relief offered by the RESULTS Act.”
What should labs do?
The RESULTS Act and other legislative proposals offer hope, but hope isn’t a strategy. The clock is ticking, and the best defense against 2027’s payment cuts is a revenue cycle that’s been stress-tested, error-checked, and optimized for resilience.
Fortunately for Synapse Lab Billing partners, our 25+ years of experience lets us navigate the ever-increasing complexity of healthcare. We are highly trained to guide labs on how to achieve a successful preparation strategy, which includes these steps:
Model different financial scenarios.
As part of your financial planning, we can forecast 2027–2029 revenue at 0%, 5%, 10%, and 15% reductions for each affected CPT/HCPCS code.
Match actual net payment to fully loaded cost
reagents, labor, equipment/depreciation, QC, repeats, courier, IT/LIS, billing, and denial cost.
Optimize the revenue cycle.
We’ll handle your front-end eligibility checks, ensure precise coding, and implement proactive denial prevention to protect your revenue.
Prioritize LIS-to-billing interfaces,
eligibility checks, order/documentation controls, claim edits, denial workflows, and payment-variance analytics.
Audit denials, eligibility failures, missing orders,
diagnosis/medical-necessity edits, authorization gaps, modifier issues, and timely-filing losses.
Labs that start now won't just survive the changes, but they'll also emerge stronger.
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Sources:
ACLA Welcomes PAMA Relief in Funding Package, Urges Congress to Advance RESULTS Act in 2026. (2016). American Clinical Laboratory Association.
https://www.acla.com/acla-welcomes-pama-relief-in-funding-package-urges-congress-to-advance-results-act-in-2026/
Bossetta, B. (2026, August 7). RESULTS Act Picks Up More Bipartisan Support As Medicare Lab Payment Reform Push Continues. Insights.
https://insights.citeline.com/medtech-insight/policy-and-regulation/legislation/results-act-picks-up-more-bipartisan-support-as-medicare-lab-payment-reform-push-continues-CIQIVDXAX5AZDMTSEMGJZQDMCQ/
CLFS & PAMA Reporting and Resources | CMS. (2026). Cms.Gov.
https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule/clfs-pama-reporting-resources
CMS Opens New Resources Ahead of 2026 PAMA Reporting Window. (2026, March 18). Myadlm.Org.
https://myadlm.org/cln/the-lab-advocate/2026/march1/cms-opens-new-resources-ahead-of-2026-pama-reporting-window
Letter from AHA, Other Organizations in Support of RESULTS Act (S. 2761/H.R. 5269) | AHA. (2025, October 31). American Hospital Association.
https://www.aha.org/lettercomment/2025-10-31-letter-aha-other-organizations-support-results-act-s-2761hr-5269