Prior authorization rates are increasing at ASCs, according to HST Pathways’ latest “State of the Industry Report.”
The report surveyed 590 ASCs in 47 states.
Here are five more insights to know:
1. In 2024, 46% of cases completed preauthorizations, up from 42% in 2023.
2. Only 24% of cases that required a preauthorization in 2024 completed it, a modest increase from 21% in 2023.
3. Insurance verification was completed in 78% of cases in 2024, up slightly from 76% in 2023.
4. ASCs saw a 4% denial rate in 2024, down from 8% the year before.
5. Reimbursement trends:
- Partial reimbursement: 56.2% in 2024 (up from 41.2%)
- Near-total reimbursement: 5.8% in 2024 (down from 7.7%)
- Total reimbursement: 17% in 2024 (down from 25.8%)
- Overpayments: 21% in 2024 (down from 25.4%)
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.