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Prior Authorization Requirements Ranked as Top Burden for the Revenue Cycle

Analysis  |  By Amanda Norris  
   October 13, 2022

A recent survey says prior authorization requirements and other regulatory burdens are weighing heavy on providers.

The recent Medical Group Management Association's (MGMA) 2022 Annual Regulatory Burden Report says 89% of respondents reported that the overall regulatory burden on their organization has increased over the past 12 months.

On top of this, prior authorization requirements ranked as the top burden for providers in the survey, with requirements stemming from the No Surprises Act and Medicare's Quality Payment Program coming in second and third.

According to the survey, 97% of respondents agreed that a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.

"Medical groups continue to face growing challenges with prior authorization, including delays in prior authorization decisions, inconsistent payer payment policies, and processing prior authorizations for routinely approved items and services," the MGMA survey said.

Because of reasons such as these, 89% of respondents stated that their practice had to hire or redistribute staff to work on prior authorizations due to the increase in requests.
"The increase in prior authorization requirements year after year is simply unsustainable," Anders Gilberg, SVP of Government Affairs at MGMA, said in a statement.

"Practices are being forced to divert resources away from delivering care to contend with these onerous and ever-changing requirements. It is time that Congress acts to put commonsense guardrails around prior authorization programs. We urge the expedient passage of the Improving Seniors' Timely Access to Care Act before the end of this year," he said.

The survey by the MGMA gathered responses from over 500 medical group practices. The group says its Government Affairs team utilizes this data to inform Congress about the obstacles faced by medical practices to delivering high-quality patient care.


Amanda Norris is the Director of Content for HealthLeaders.


If your revenue cycle staff seems underwater due to prior authorization requirements, you're not alone.

The increase in prior authorization requirements year after year is being called unsustainable.

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