The growing burden of prior authorization

The burden of prior authorization is growing as "payers seek new strategies to reduce outlays," according to a June 24 blog post from Coronis Health. 

Here are five key notes from the blog post:

1. Around 88 percent of physicians reported that prior authorizations put a high or extremely high burden on their practice, according to a 2022 American Medical Association survey, with practices completing an average of 45 authorizations per physician each week. 

2. This high volume of prior authorizations requires physicians and staff to redirect time from patient care to make phone calls, obtain and fill out forms, and collect and submit medical documents and appeal denials. 

3. There have been efforts to reform the Medicare Advantage prior authorization process. A bill sponsored by 30 U.S. Representatives and 42 Senators will aim to establish an electronic prior authorization process, increase transparency on requirements and clarify the HHS' authority to establish time frames, among other changes. 

4. In January, CMS finalized a rule to streamline the process and improve the electronic exchange of health information for federally-funded payers. Additionally, beginning in 2026, certain payers will be required to include a specific reason when denying requests and send decisions within 72 hours for urgent requests and seven calendar days for standard requests, among other requirements. 

5. In the meantime, according to the report, providers shouldn't force insured patients to agree to pay out-of-pocket for services that require a prior authorization, and instead "hang in there and wait for the cavalry to arrive," as this issue is expected to ease soon. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast