Michael Stephenson

In 2021, when the Evaluation and Management guidelines were revised, the area with the most confusion was ultimately the amount and/or complexity of data to be reviewed and/or analyzed. Like with other components, misunderstandings with definitions and descriptions were at the root of the problem.

The challenges prior authorization presents to healthcare groups and physicians continue to increase. A 2021 American Medical Association (AMA) survey found that 93% of physicians report that prior authorization results in care delays. One-third said that prior auth delays have caused at least one of their patients to experience a serious problem, such as hospitalization, disability, and even death.

Prior authorization is here to stay. Insurance companies are increasing Prior Authorization (PA) requirements for medical services and prescription drugs. As a result, the PA administrative load is getting heavier for healthcare providers.