A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time.
The public reporting mandate arrives after years of mounting frustration over prior auth from providers. Here are 10 numbers to know about prior authorization:
1. The average medical practice completed 39 prior authorizations per physician per week in 2024, with physicians and staff spending about 13 hours weekly on paperwork, according to an American Medical Association survey.
2. Twenty percent of physicians said they always appeal an adverse prior authorization decision. About two-thirds said they do not appeal if they do not think the appeal will be successful, and more than half said they do not appeal if they have insufficient resources or time.
3. Thirty-one percent of physicians said prior authorizations are often or always denied.
4. Three in 4 physicians said the number of prior authorization denials has “increased somewhat or significantly” over the last five years.
5. Nearly 9 in 10 reported that the prior authorization process somewhat or significantly increases burnout.
6. Prior authorization rates are increasing at ASCs, according to HST Pathways’ latest State of the Industry report, which surveyed 590 ASCs across 47 states.
7. Forty-six percent of ASC cases completed preauthorizations in 2024, up from 42% in 2023.
8. While only 24% of cases that required prior authorization completed the process in 2024, a modest increase from 21% the year prior, the rising volume of cases subject to prior authorization adds to the administrative load.
9. In MA alone, insurers fully or partially denied 4.1 million prior auth requests, or 7.7% of the total, in 2024, according to KFF data. More than eight in ten appeals were ultimately overturned.
10. Nearly 97% of providers have seen delays or denials for necessary patient care due to prior authorization requirements, according to the Medical Group Management Association’s 2023 “Regulatory Burden Report.”
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