What a Prior Authorization Backlog Actually Costs a Small Practice

A prior authorization backlog costs a small practice in three places: the staff hours spent chasing approvals, the visits that get pushed or lost while approvals are pending, and the claims that are denied because an approval was missing or did not match. The first cost is easy to estimate. The other two rarely show up on any report, which is why most practices underestimate the total.

Prior authorization is a health plan’s requirement that a provider get approval before delivering certain tests, procedures or medications. For a small practice without a dedicated authorization team, the work tends to pile up quietly until it shows up as a scheduling problem or a cash flow problem. That is why more practices now give the queue a named owner, hired in house or added as a remote specialist through managed staffing providers such as myMedCrew.

How Much Staff Time Does Prior Authorization Take?

In the American Medical Association’s 2025 survey of 1,000 practicing physicians, practices completed an average of 40 prior authorizations per physician each week, and physicians and their staff spent 13 hours a week on them (American Medical Association, 2025). Forty percent of physicians said they have staff who work exclusively on prior authorization.

The per request cost is measurable too. The 2024 CAQH Index puts the provider side cost of one prior authorization at $12.88 when it is done by phone, fax or email, and $8.93 through a health plan portal. Staff reported spending 24 minutes on a manual request and 16 minutes on a portal request (CAQH, 2025).

Put those together for a three physician practice. At 40 requests per physician, that is about 120 requests a week. At CAQH’s per request costs, that works out to roughly $1,070 to $1,550 a week, or $56,000 to $80,000 a year, before counting a single delayed visit or denied claim. The 39 combined hours a week is close to one full time role, whether or not anyone holds that title.

This is not a new problem, only a bigger one. A study in the Journal of the American Board of Family Medicine found that clerical and physician time made up the largest share of prior authorization costs in primary care offices, as physician time was shifted onto clerical staff (Morley et al., 2013).

The Costs That Never Reach a Report

The staff time is visible. These costs usually are not.

Rescheduled and abandoned visits. In the same AMA survey, 95% of physicians said prior authorization delays access to care at least sometimes, and 79% said it at least sometimes leads patients to abandon a recommended treatment. Seventy three percent reported that prior authorization leads to additional office visits (American Medical Association, 2025). Every visit that moves because an approval is not back is a slot that has to be refilled, and every abandoned treatment plan is revenue the practice never sees.

Idle provider time. When an approval lands late on the day of service, the visit is cancelled or rescheduled at the last minute. The provider’s time was blocked for that patient, and at short notice it is hard to fill.

Overtime. Authorization work does not stop at 5 pm. When it is shared between the front desk and medical assistants, it is often caught up after hours, which turns a workflow problem into a payroll line.

Denials and unworked appeals. In KFF’s analysis of 2023 HealthCare.gov insurer data, 9% of denied in network claims were denied for lack of prior authorization or referral (KFF, 2025). Appeals are where some of that money comes back, but only 21% of physicians in the AMA survey said they always appeal an adverse decision, and 52% of those who do not appeal said they lack the staff or time (American Medical Association, 2025).

Where Do Prior Authorization Requests Stall?

Backlogs are rarely caused by one big failure. They come from the same few small ones, repeated across dozens of requests:

• The requirement is spotted at check in instead of at scheduling, so there is no time to get the approval before the visit.
• The request goes out and nobody tracks it. A payer asks for more documentation and the request sits for a week.
• The approval comes back for a different code, fewer units or a shorter window than what is delivered and billed.
• Requirements change. In the AMA survey, 62% of physicians said it is difficult to know whether a medical service needs prior authorization at all (American Medical Association, 2025).

Track Turnaround by Payer, Not on Average

A single “average turnaround” hides the real problem. Most practices find that one or two payers account for most of the slow or denied requests. A simple authorization log fixes that: for every request, record the payer, CPT code, date submitted, status, approval number, approved units, expiry date and date decided.

Review it monthly by payer. Federal rules now help on part of the book. Under the CMS Interoperability and Prior Authorization Final Rule, Medicare Advantage, Medicaid and CHIP payers must decide standard requests within seven calendar days and urgent requests within 72 hours from January 1, 2026, and must give a specific reason for each denial (Centers for Medicare & Medicaid Services, 2024). The log shows whether each payer is actually meeting those timeframes, and gives the practice the dates it needs when it is not. Commercial plans outside the rule keep their own timelines, which makes tracking them even more important.

For more on how health systems and vendors are tackling the problem, see Medigy’s prior authorization topic hub.

Who Should Run the Queue?

The most expensive staffing model is the most common one: prior authorization shared between whoever has a spare minute. Shared ownership means no one works the pending list every day, and requests go stale.

Small practices have three workable options:

1. A dedicated in house coordinator.Best when volume is steady and the practice can absorb hiring, training and backup cover.
2. A named owner on the existing team with protected hours.Works at lower volume, as long as those hours do not disappear on busy clinic days.
3. A remote specialist through a managed staffing provider.Some practices add pre-vetted billing and prior authorization specialists through managed staffing providers, who work inside the practice’s own EHR and payer portals while the provider handles payroll and replacements.

Whichever model a practice picks, the practice should keep the clinical and financial decisions, such as whether to appeal or reschedule, and the person running the queue should be connected to billing so every approval is checked against the claim before it goes out. Because prior authorization requests carry diagnoses and patient identifiers, anyone handling them, on site or remote, should work with multi factor authentication, encrypted access, role based access and audit logging.

Key Takeaways

• A three physician practice can spend roughly $56,000 to $80,000 a year on prior authorization staff time alone, based on AMA volumes and CAQH per request costs.
• The larger costs are indirect: rescheduled and abandoned visits, idle provider time, overtime and denials that never get appealed.
• Most backlogs come from a few repeat failures: late checks, untracked requests, mismatched approvals and changing rules.
• Track turnaround by payer, and give the queue one named owner connected to billing.

References

1. American Medical Association. (2025). *2025 AMA prior authorization physician survey*. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
2. CAQH. (2025). *2024 CAQH Index report: From transactions to trust*. https://www.caqh.org/hubfs/Index/2024%20Index%20Report/CAQH_IndexReport_2024_FINAL.pdf
3. Centers for Medicare & Medicaid Services. (2024). *CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)* [Fact sheet].
4. KFF. (2025). *Claims denials and appeals in ACA Marketplace plans in 2023*.
5. Morley, C. P., Badolato, D. J., Hickner, J., & Epling, J. W. (2013). The impact of prior authorization requirements on primary care physicians’ offices: Report of two parallel network studies. *Journal of the American Board of Family Medicine, 26*(1), 93 to 95. https://doi.org/10.3122/jabfm.2013.01.120062

About the Author

Adwait Rajhans is Head of GTM and Revenue Strategy at myMedCrew, the healthcare staffing arm of CrewBloom, where he works with practices on staffing their billing, revenue cycle and front office operations. Connect with him on LinkedIn.