The challenge of prior authorization is unlikely to get better anytime soon. There may be two opportunities for improvement as follows: technical solutions that may lower the administrative burden and legal remedies that could shorten the approval timeline.

The burden of insurer prior authorization of medical procedures is well documented, and health care providers increasingly complain of its effect on patient care and their workloads per Part B News (PBN). In its most recent survey on the issue, the Medical Group Management Association (MGMA) found that 83% of practices called these requirements “very or extremely burdensome,” with 90% saying that they had gotten more onerous in the preceding year (PBN).

Prior authorization requirements are considered a primary driver of physician burnout. Patients are experiencing needless delays in care that are negatively impacting the quality of care they receive.

CMS has suggested that automation can make the process more efficient. CMS has to date “conducted 35 listening sessions and elicited over 2,000 stakeholder comments” related to the subject. MGMA is working with CMS to make sure industry concerns are heeded as the project develops. Rob Tennant, director of health information technology policy for MGMA, says his organization is “encouraged” by the project.

Technological fixes to the rigors of prior auth are also being explored in the private sector. The insurance industry group AHIP announced Jan. 6, 2020, that it was launching its Fast Prior Authorization Technology Highway (Fast PATH) to “speed prior authorization review and approval” through a portal among participating insurers and providers.

Payers, including CMS, have a strong financial motive not to scale back prior authorization.  Prior auth creates an impediment to obtaining payment for services, and impediments tend to discourage some claimants.

Some states have stepped up with bills setting their own prior auth standards for payers. Kentucky’s law, which went into effect Jan. 1, requires that some requests be returned in 24 hours and others within five days. Illinois is considering a similar bill.

We have consistently heard from various physician organizations that prior authorization is a costly and time-consuming step. This may be a situation where a combination of technology and state law solves this difficult challenge for physicians providing needed medical services.