On February 24, 2025, the American Medical Association released the results of its latest prior authorization physician survey, a web survey conducted in December 2024 among 1,000 practicing physicians, 40 percent in primary care and 60 percent in specialties. The numbers are not surprising to anyone who runs an authorization desk, but they are worth having in front of you, because the federal rule that is supposed to change payer behavior, CMS-0057-F, has its first deadlines less than a year away, and practices should decide now what they will measure.
We read the survey the way we read a denial report: not for the headline, but for the parts a practice can act on. The AMA is making a policy argument to Congress and to insurers. A practice manager has a narrower problem, which is that authorizations consume staff hours today and cause CO-197 denials next month, and neither the survey nor the rule will fix that without a log the practice keeps itself.
Key takeaways
- The survey puts the clinical cost of prior authorization in plain numbers: 93 percent of physicians report delayed care and 29 percent report a serious adverse event for a patient in their care.
- CMS-0057-F requires Medicare Advantage and Medicaid plans to decide standard requests within 7 calendar days and expedited requests within 72 hours from January 1, 2026, and to give a specific reason for every denial.
- Electronic prior authorization through payer APIs is not required until January 1, 2027, and employer commercial plans are outside the rule entirely.
- The practice's side of the work is a single authorization log with turnaround, outcome and denial reason by payer. Build it this year, in a spreadsheet if necessary.
What the survey found
| Finding | Share of physicians |
|---|---|
| Prior authorization delays access to necessary care | 93 percent |
| Prior authorization contributes to physician burnout | 89 percent |
| Prior authorization has led to a serious adverse event for a patient in their care | 29 percent |
| Of those, an event that led to hospitalization | 23 percent |
| Of those, a life-threatening event or one requiring intervention to prevent permanent damage | 18 percent |
| Of those, permanent disability, a congenital anomaly, or death | 8 percent |
| Prior authorization can lead patients to abandon a recommended course of treatment | 82 percent |
| Prior authorization leads to higher overall use of health care resources rather than savings | About nine in ten |
The survey also repeated the workload questions it has asked for years. Physicians reported handling close to 40 prior authorization requests per physician per week, consuming roughly 13 hours of physician and staff time, and a large minority of practices have staff who work on nothing else. The AMA's framing was that the insurers' own 2018 consensus statement on reforming prior authorization has not been kept.
We would add a practical point: the survey measures physician experience, not practice cost. The cost side is the staff hours, the delayed dates of service and the denials that come from authorizations that were never obtained. Both are real and only one shows up in your financials. A practice with two authorization coordinators at a loaded cost of roughly $55,000 each is spending $110,000 a year to get permission to provide care it is already contracted to provide, before counting a single denied claim.
What CMS-0057-F requires, and when
CMS released the Interoperability and Prior Authorization final rule (CMS-0057-F) on January 17, 2024. It applies to Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid and CHIP managed care plans, and qualified health plan issuers on the federally facilitated exchanges. It does not apply to employer commercial plans, and it does not cover prior authorization for drugs.
| Requirement | Who | Deadline |
|---|---|---|
| Decision within 72 hours for expedited requests and 7 calendar days for standard requests | Impacted payers except qualified health plans on the federal exchanges | January 1, 2026 |
| Specific reason for every prior authorization denial, regardless of submission method | All impacted payers | January 1, 2026 |
| Public reporting of prior authorization metrics (approvals, denials, appeals, turnaround) on the payer's website, annually | All impacted payers | First reports by March 31, 2026 |
| Prior Authorization API, Provider Access API, Payer-to-Payer API and updated Patient Access API | All impacted payers | January 1, 2027 |
| Electronic prior authorization measure in the MIPS Promoting Interoperability category | MIPS eligible clinicians | 2027 performance year |
Two cautions. The rule does not require a payer to approve anything; it requires speed, a reason and transparency. And the 7-day standard is a ceiling that many Medicare Advantage plans already meet on paper while the practice waits two weeks for the fax confirmation. The value for a practice comes from the specific denial reason and from the published metrics, which will make it possible to compare plans in the same market and to bring numbers, not anecdotes, to a contract negotiation.
Who this affects
Every practice that treats Medicare Advantage or Medicaid managed care patients, which is nearly every practice. Employer-sponsored commercial plans are outside the rule, and they are where the survey respondents spend most of their authorization time. State laws are filling some of that gap; several states have passed their own turnaround and gold-card statutes (a gold card exempts a provider with a high approval rate from authorization for a period), and the rules differ by state, so check yours. In our experience the state medical society keeps the best summary of what applies to state-regulated plans, and the practice's own contracts govern the rest.
What changes in the practice's workflow
Not much in 2025. The change in 2026 is that a Medicare Advantage denial must come with a specific reason, which makes appeals easier to write and makes patterns easier to see. The change in 2027 is that the request itself can move through the EHR rather than a portal or fax, if your EHR vendor builds the connection. What a practice can do now is build the measurement that will let it hold payers to the rule later.
- One authorization log, whatever the tool: patient, payer, service and CPT code, date requested, method, date decided, outcome, denial reason, appeal date, appeal outcome, date of service.
- Turnaround by payer, calculated monthly from the log: median days from request to decision, and the share that exceeded 7 calendar days for standard requests. When the rule takes effect, that number is your evidence.
- Denial reason categories: not medically necessary, missing information, non-covered, site of service, wrong code. "Missing information" is the one the practice controls, and in our experience it is the largest.
- Services scheduled before authorization was confirmed. This is the source of most CO-197 denials. Count them every month and give the number to the scheduling lead.
- Peer-to-peer requests and outcomes, so the providers who spend the time can see whether it works with each payer.
The numbers to watch, with an example
A practice with a working authorization desk usually sees CO-197 denials below two percent of claims, a median commercial turnaround of three to five business days on standard requests, and a "missing information" share that falls month over month once the request checklist is fixed. If your CO-197 rate is above five percent, the problem is almost always scheduling ahead of the authorization, not the payer.
Here is what the log shows after one quarter at a fictional orthopedic practice that requests about 300 authorizations a month. Payer A decided standard requests in a median of 4 days, denied 9 percent, and 60 percent of its denials were "missing information". Payer B decided in a median of 11 days, denied 14 percent, and half of its denials were "not medically necessary" for the same MRI codes. The fix for Payer A is inside the practice: a request checklist that attaches the conservative treatment history the first time. The fix for Payer B is a conversation with the payer's provider representative, with the log as the exhibit, and, after January 2026, a written record of every request that exceeded seven days. Without the log, both problems look like "insurance is slow", and nothing changes.
Questions we hear
Should we wait for the 2027 APIs before investing in authorization software?
Do not wait for the APIs to build the log. The log is a spreadsheet if it has to be. Software that plugs into payer portals today still helps, but it should be judged on whether it produces the turnaround and denial-reason data above, not on how many payers it claims to connect to. Ask any vendor to show you its turnaround-by-payer report on a live account before you sign.
Does gold carding help?
Where a state law or a payer program exempts high-approval providers from authorization, yes, and the survey found physicians want it. The programs are payer-specific and state-specific. Ask each of your top payers whether one exists and what the qualifying approval rate is, and keep your own approval rate by payer in the log so you can prove you qualify.
Can a billing company run the authorization desk?
Some do, some do not. Revelrex handles authorization-related denials and appeals within denial management, and our RCM audit measures the CO-197 rate and the scheduling gap that causes it. Whether the request itself is made in-house or outsourced, the log described above is the part that cannot be skipped.
What to do this month
- Start the authorization log with the eleven fields above, or confirm the existing tool captures all of them.
- Pull the last quarter's CO-197 denials and count how many were for services scheduled before the authorization was confirmed.
- Write the request checklist for the five most-authorized services, including the clinical elements the payer policy asks for.
- Identify which of your payers are Medicare Advantage or Medicaid managed care and therefore subject to the 2026 deadlines.
- Ask your state medical society for the current summary of state prior authorization and gold-card laws.
- Ask your EHR vendor whether it plans to support the payer Prior Authorization API by 2027.
