January 21, 2020
MGMA alarmed by new evidence of increasing prior authorization costs for physician practices
Statement by Anders Gilberg, Senior Vice President of Government Affairs
“The just released CAQH 2019 Index confirms MGMA’s findings that the financial burden of prior authorization requirements on physician practices is increasing at an alarming rate. In 2020, practices should not be forced to rely on fax machines to complete manual prior authorizations when health plans could modernize the process. The federal government needs to streamline prior authorization by requiring a national automated approach to minimize administrative costs and delays in patient care.”
The CAQH 2019 Index revealed that the cost for providers to manually generate a prior authorization increased more than 60% from $6.61 in 2018 to $10.92 in 2019. Payer cost for the same transaction decreased from $3.50 in 2018 to $3.32 in 2019. Conversely, cost for providers to generate an electronic prior authorization transaction dropped from $2.80 in 2018 to just $1.88 in 2019 and payer cost stayed steady. Overall industry use of electronic transactions increased only slightly from 12% to 13%.
Associate Director, Public Affairs
202.293.3450 x 1351
Medical Group Management Association (MGMA)
is the premier association for professionals who lead medical practice. Since 1926, through data, people, insights, and advocacy, MGMA empowers medical group practices to innovate and create meaningful change in healthcare. With a membership of more than 55,000 medical practice administrators, executives, and leaders, MGMA represents more than 15,000 organizations of all sizes, types, structures and specialties that deliver almost half of the healthcare in the United States.