In the complex world of prior authorization services for internal medicine, physicians are responsible for managing chronic conditions, coordinating multi-specialty care, and ensuring timely interventions. But one major roadblock often stalls this process: delayed prior authorizations. While intended to control healthcare costs, the prior authorization (PA) process can have a serious, often hidden, financial and clinical impact on internal medicine practices. Understanding these hidden costs—and how to address them—is essential for improving patient care, enhancing practice efficiency, and safeguarding revenue.
Understanding Prior Authorization Delays
Prior authorization is a payer-imposed requirement that mandates healthcare providers receive approval before delivering specific services, tests, or medications. For internal medicine, this can include diagnostics (like MRIs, CT scans), specialty medications, durable medical equipment (DME), and referrals to specialists.
Delays in this process arise from incomplete documentation, changing payer rules, manual workflows, and limited staff bandwidth. A 2022 AMA survey found that 94% of physicians experienced care delays due to PA, and 33% reported that these delays led to serious adverse events.
Hidden Cost #1: Revenue Loss and Workflow Disruption
Every delayed authorization represents time during which a patient cannot be treated, and providers cannot bill. This impacts the revenue cycle in multiple ways:
Missed Appointments and Service Cancellations: If a test or procedure doesn’t receive timely approval, patients often reschedule or cancel—leading to empty slots and lost income.
Delayed Billing Cycles: Reimbursement is postponed until services are rendered and approved, which stretches accounts receivable days and tightens cash flow.
Denials and Write-Offs: A delay often snowballs into a denial if services are rendered without approval, forcing practices to either appeal or absorb the cost.
A single delayed procedure costing $500–$1000, multiplied across dozens of cases monthly, adds up to tens of thousands of dollars in unrealized revenue per year.
Hidden Cost #2: Physician and Staff Burnout
Prior authorization isn’t just an administrative task—it’s a burden that consumes valuable clinical time. Internal medicine physicians, already pressed for time managing chronic care plans and medication adjustments, often have to:
Write detailed clinical justifications
Make peer-to-peer calls with insurers
Monitor pending authorizations across multiple systems
This creates non-clinical workload creep, contributing to burnout and dissatisfaction. According to the American College of Physicians (ACP), internal medicine sees some of the highest burnout rates—prior authorization being a key contributor.
Moreover, front-office and medical billing services staff experience high turnover due to repetitive manual tasks and payer rejections, leading to retraining costs and further inefficiencies.
Hidden Cost #3: Patient Attrition and Trust Deficit
Patients rely on internists to coordinate care and act quickly. When necessary diagnostic tests or medications are delayed due to PA, patients suffer:
Delayed diagnoses (e.g., missing early signs of cancer or heart disease)
Interrupted chronic care management (especially for diabetes, hypertension, or autoimmune disorders)
Emotional distress and confusion over "why their doctor can’t help them"
This erodes trust. A patient who repeatedly experiences delays may switch to another provider, especially if they're dealing with serious health concerns. That translates into long-term revenue loss and reputational harm.
Hidden Cost #4: Compliance Risks and Legal Exposure
Failing to obtain proper authorization or bypassing the process to avoid delays can result in:
Insurance audits and clawbacks
Civil penalties for non-compliance
HIPAA violations if patient documentation is mishandled during appeals
Internal medicine practices that lack standardized PA protocols face increased exposure to payer scrutiny, especially from Medicare Advantage and commercial insurers with strict pre-certification requirements.
How to Fix the Problem: Solutions That Work
1. Standardize and Centralize Prior Authorization Workflows
The first step to minimizing delays is creating standard operating procedures (SOPs):
Use checklists for each insurer’s PA requirements.
Centralize documentation and submission workflows using a shared dashboard.
Set internal SLAs for submitting PAs within 24–48 hours of an order.
Tip: Create templates for common medications and procedures that often require PA, so documentation can be quickly copied and customized.
2. Automate Where Possible
Technology is a powerful ally. Several EHRs and third-party platforms offer automated prior authorization solutions, including:
Electronic Prior Authorization (ePA): Integrated with e-prescribing tools to check PA requirements in real-time.
AI-based PA tools: These use historical approval data to predict payer responses and pre-fill forms.
Real-time dashboards: Track status of pending authorizations to reduce missed approvals.
By automating up to 70% of PA submissions, internal medicine clinics can reduce staff workload, improve turnaround time, and increase approvals on the first attempt.
3. Outsource to a Prior Authorization Service
If in-house staff are overwhelmed or untrained, outsourcing may be the right call. Professional prior authorization services:
Handle all payer communication and documentation
Reduce error rates
Monitor approvals and denials in real time
Follow up on missing documentation or peer reviews
This allows physicians to focus on clinical care while reducing administrative overhead and boosting operational efficiency.
4. Train and Empower Staff
Provide training on:
Understanding different payer policies and portals
Efficient documentation of medical necessity
Avoiding common coding errors that trigger denials
Empower your medical assistants and front-desk teams to initiate the PA process as soon as a referral or order is generated. Early submission leads to faster approval.
5. Track Metrics and Optimize Continuously
Key performance indicators (KPIs) to monitor:
Average PA turnaround time
Approval rate on first submission
Denial rate by payer or procedure
Number of rescheduled/canceled appointments due to PA delays
Use this data to identify bottlenecks, train staff further, or shift to more efficient tools and services.
6. Educate Patients
Make patients part of the process by:
Clearly explaining the reason and timeline for prior authorizations
Providing written or digital updates on approval status
Offering alternatives if approval takes longer than expected
A transparent approach improves patient satisfaction and reduces no-shows or complaints.
Conclusion: Small Fixes, Big Gains
Delayed authorizations in internal medicine come with a cost far greater than lost time—they impact revenue, staff morale, patient outcomes, and compliance. But these issues are solvable. By standardizing workflows, leveraging automation, outsourcing where necessary, and keeping patients informed, practices can transform prior authorization from a burden into a competitive advantage.
The internal medicine landscape is already complex enough. Don’t let prior authorization delays become the reason your practice lags behind. Start small, measure progress, and commit to continuous improvement—your bottom line and your patients will thank you.
