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Prior Authorization Is Costing Your Practice 16+ Hours Per Week: Here’s How to Fix It

Prior authorization has become one of the most burdensome administrative tasks in modern healthcare. What was originally designed as a cost-control measure has evolved into a time-consuming process that drains resources from medical practices of all sizes. Research consistently shows that the average medical practice spends 16 or more hours per week navigating the prior authorization maze, and for many practices, the real number is significantly higher.

This isn’t just an inconvenience. Those lost hours translate directly into delayed patient care, frustrated staff, physician burnout, and substantial financial losses. But there are practical solutions that can dramatically reduce this burden.

The True Cost of Prior Authorization

The 16-hour weekly figure often cited is actually conservative. A survey by the American Medical Association found that practices complete an average of 41 prior authorizations per physician per week, with each one taking roughly 14 minutes of physician and staff time combined. For a practice with multiple physicians, this quickly compounds into a full-time job or more.

The costs extend beyond just time. Consider the ripple effects: appointments get delayed while waiting for authorization approvals, staff members become demoralized dealing with repetitive bureaucratic tasks, physicians experience burnout from non-clinical administrative work, and patients become frustrated with delays in receiving necessary treatments. Revenue also takes a hit when procedures can’t be scheduled promptly or when authorizations are denied and require appeals.

Understanding the Bottlenecks

Before implementing solutions, it’s important to identify where your practice is losing the most time. Common bottlenecks include gathering and submitting required clinical documentation, navigating different portals and requirements for each insurance company, following up on pending authorizations, managing denied authorizations and appeals, and communicating status updates to patients.

Many practices also lack standardized workflows, meaning staff members handle authorizations differently, leading to inefficiencies and errors. Without proper tracking systems, authorizations can slip through the cracks or get duplicated.

 Implement Dedicated Prior Authorization Software

One of the most impactful changes you can make is investing in specialized prior authorization software. These platforms integrate with your electronic health record system and automate many of the repetitive tasks that consume staff time.

Quality prior authorization platforms can automatically check whether a procedure requires authorization based on the patient’s insurance, pull relevant clinical documentation from the EHR, submit authorizations electronically to multiple payers, track authorization status in real-time, and send automatic alerts for approvals, denials, or requests for additional information.

The upfront cost of these systems is typically recouped within months through time savings and reduced denials. When evaluating options, look for platforms with broad payer connectivity, strong EHR integration, user-friendly interfaces for staff, and robust reporting features to track your authorization metrics.

 Standardize Your Workflow

Even with technology, having a clear, standardized process is essential. Create a documented workflow that every staff member follows, which should include checking authorization requirements at the time of scheduling, gathering all necessary documentation upfront, submitting authorizations with complete information the first time, establishing a regular schedule for following up on pending authorizations, and having a clear escalation process for denials.

Assign clear roles and responsibilities. Designate specific team members to handle prior authorizations and ensure they receive proper training. Consider having specialists focus on particular insurance companies or procedure types so they develop expertise with those specific requirements.

 Build Payer-Specific Templates

Each insurance company has different documentation requirements, and one of the biggest time-wasters is figuring out what information to submit. Create templates for your most common procedures with each major payer, including all required clinical information, necessary supporting documentation, and specific codes or language the payer expects to see.

Update these templates whenever requirements change, and maintain a shared digital library that all staff can access. This eliminates redundant research and ensures authorizations are submitted correctly the first time.

 Leverage Your EHR More Effectively

Most practices underutilize their existing EHR capabilities for prior authorization. Work with your EHR vendor or IT team to set up documentation templates that capture required prior authorization information during the clinical encounter itself, create smart forms that auto-populate with patient data, build alerts that flag when orders will require authorization, and establish quick links to commonly used payer portals.

The goal is to make it as easy as possible for providers to document what’s needed for authorization success at the point of care, rather than having staff hunt through charts later.

Consider Outsourcing or Virtual Assistants

For practices drowning in prior authorization work, outsourcing can be a viable solution. Specialized medical billing companies and virtual assistant services can handle prior authorizations at a lower cost than hiring additional in-house staff. This can be especially valuable for smaller practices that can’t justify a full-time prior authorization specialist.

When outsourcing, ensure the service has experience with your specialty, uses secure HIPAA-compliant systems, provides regular status updates and reporting, and maintains clear communication channels with your in-house team.

Improve Communication with Providers

Physicians often don’t realize how much their documentation habits affect prior authorization efficiency. Provide regular feedback to your providers about common reasons for authorization delays or denials, create pocket guides with key information needed for frequently authorized procedures, and establish a quick consultation process when authorization staff need clinical clarification.

Some practices have found success with brief weekly huddles where authorization staff can ask questions and providers can understand current challenges. This collaborative approach tends to improve documentation quality and reduce back-and-forth.

Track Metrics and Continuously Improve

You can’t improve what you don’t measure. Start tracking key metrics such as total staff hours spent on prior authorizations per week, average time to approval by payer and procedure type, first-submission approval rate, denial rate and common denial reasons, and appeals success rate.

Review these metrics monthly and look for patterns. If certain payers consistently take longer or deny more often, you can develop targeted strategies. If specific procedure types have low first-submission approval rates, you can improve those templates and processes.

Advocate for Policy Change

While fixing internal processes is crucial, the prior authorization burden also requires systemic solutions. Many medical associations and advocacy groups are pushing for reforms such as standardization of prior authorization processes across payers, exemptions for routine or urgent procedures, gold carding programs that exempt high-performing providers, and real-time electronic prior authorization.

Encourage your practice leadership to engage with these advocacy efforts, share your data with legislators and regulators, and participate in pilot programs for streamlined authorization processes when available.

Calculating Your Potential Savings

To build a business case for investing in prior authorization solutions, calculate your current costs. Multiply your weekly staff hours on prior authorization by your average hourly wage (including benefits), add the cost of delayed procedures and lost revenue, factor in the hidden costs of physician time and burnout, and consider the impact on patient satisfaction and retention.

For many practices, even a 50% reduction in prior authorization time can save tens of thousands of dollars annually while significantly improving staff morale and patient care.

Getting Started

Tackling the prior authorization problem doesn’t require overhauling your entire practice overnight. Start by measuring your current time and costs to establish a baseline, identifying your biggest pain points through staff input, implementing one or two high-impact solutions first, and measuring results and adjusting your approach.

Many practices find that combining technology solutions with workflow improvements yields the best results. The specific mix will depend on your practice size, specialty, payer mix, and current systems.

The Bottom Line

Sixteen hours per week represents just the average, but every practice deserves better. Prior authorization is unlikely to disappear, but with the right combination of technology, processes, and advocacy, you can dramatically reduce its burden on your practice. The time and resources you reclaim can be redirected toward what matters most: providing excellent patient care and maintaining a sustainable, fulfilling practice for your team.

The question isn’t whether you can afford to address the prior authorization problem. It’s whether you can afford not to.