Prior authorization has been consistently identified by clinicians and administrators alike as a significant burden to surgical care and ASC workflows.
Ninety-three percent of physicians reported that PA can cause care delays at least some of the time, according to the American Medical Association’s “2025 AMA Prior Authorization Physician Survey” released May 13. Another 82% reported that PA can at least sometimes lead to patients abandoning treatment plans. Notably, zero physicians in the survey said PA never caused treatment plan abandonment.
Question: How would you describe the level of burden prior authorization puts on your ASC? What are your strategies for successfully navigating prior authorization?
Julie Jackson, NP. Chief Administrative Officer of GI Associates (Milwaukee): Prior authorization creates a significant administrative burden for ASCs because it adds work at multiple points in the patient journey — from scheduling and clinical documentation to payer follow-up, denial prevention, and appeals. The burden is not limited to the authorization itself; it also affects access, staff productivity, physician schedules and patient experience when approvals are delayed or requirements change close to the procedure date. Our strategy is to treat prior authorization as an operational workflow, not a back-end billing function. We have every leader at our organization understanding we are all responsible for the entire revenue cycle process. That means building strong front-end verification processes, maintaining clear payer-specific requirements, educating scheduling and clinical teams, monitoring denial trends, and escalating issues early when payer criteria do not align with medical necessity or appropriate site-of-service decisions. The most effective approach is proactive, standardized, and data-driven: know the payer rules, document thoroughly, communicate clearly with patients and physicians, and track patterns so the ASC can address recurring barriers before they disrupt care.
Darlene Isola. Administrator of Surgery Center of Central New Jersey (North Brunswick): Prior authorizations place a significant burden on ASCs, as they rely on physician offices to obtain the necessary approvals. When authorizations are not received in a timely manner, surgeries may be delayed or canceled, disrupting schedules for surgeons and staff while creating unnecessary stress and anxiety for patients. In addition, if complications arise during surgery and the procedure performed differs from what was originally authorized, the existing authorization is no longer valid. This requires staff to obtain an updated authorization as quickly as possible to avoid reimbursement denials.
To minimize these challenges, ASCs can implement policies requiring prior authorizations to be obtained before elective surgeries are scheduled, except in urgent or emergent cases. Furthermore, physician offices should also request authorization for multiple CPT codes when appropriate. This can help ensure reimbursement if the surgical plan changes due to surgical complications, while reducing administrative burdens, preventing delays, and improving the overall patient experience.
Lauren Phillips, BSN. Director of Invasive Services at The Cardiac and Vascular Institute (Chiefland, Fla.): Prior authorization requirements for cardiovascular and peripheral procedures in the ambulatory surgery center setting have become increasingly complex, requiring more extensive clinical documentation and resulting in longer approval times. At our ASC, procedures are rescheduled if authorization has not been obtained at least 48 hours before the scheduled date to minimize last-minute cancellations and maintain operational efficiency. While this policy supports effective scheduling, increasing authorization delays can postpone medically necessary care, increase administrative burden, and negatively impact both patient access and ASC operations.
Raghu Reddy. Chief Administrative Officer MiOrtho Surgery Center (Southfield, Mich.): Prior authorization places a significant burden on our ASC because payer rules vary by insurance plan, procedure, implant, and site of service. These requirements can delay surgery, create extra work for clinic schedulers, frustrate patients, and lead to denials or lost operating-room time.
At MiOrtho, we start the process early by confirming insurance coverage, authorization requirements, correct coding, medical necessity, and supporting documentation before the case is finalized. We closely track pending authorizations and quickly escalate cases that may delay surgery. Moving forward, we plan to use AI technology to identify payer requirements, review documentation for missing information, automate follow-up, and alert staff when action is needed.
This should reduce the administrative burden on clinic schedulers while improving accuracy, turnaround time, and the patient experience, hopefully, this tech is around the corner.
Scott Shapiro, MD. Cardiologist at AMS Cardiology (Horsham, Pa.): Prior authorization can be a burden, particularly as more cardiovascular care moves into the outpatient setting. ASCs are delivering high-quality care in a setting that can be more efficient and cost-effective for patients and the healthcare system, yet the authorization process can still create delays and consume significant staff time. It also drives up the cost of healthcare for everyone. Our approach is to build the operational infrastructure and payer expertise and partnerships needed to navigate those requirements efficiently, allowing physicians to stay focused on clinical decisions and getting patients the right care in the right setting.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.