1
PA Process Audit
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Document all authorization types your practice currently handles
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Track time spent per authorization by payer and service type
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Calculate total PA cost: physicians × hours/week × staff cost × 52
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Identify which payers have the highest PA denial rates
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Map which services require PA for each of your top payers
2
Cost Analysis by Payer
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Rank payers by PA volume (highest to lowest)
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Calculate cost per PA submission for each payer ($20-30 avg)
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Track appeal rate and appeal success rate by payer
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Identify the 2-3 payers representing 60-80% of total PA volume
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Calculate revenue lost to PA-related treatment abandonment
3
CMS-0057-F Compliance Timeline
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January 2026: Payers must respond within 72h (urgent) / 7 days (standard)
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March 2026: Payers begin public reporting of PA metrics
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January 2027: Payers must implement FHIR-based PA APIs
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Evaluate your EHR’s readiness for FHIR API integration
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Develop internal workflow to leverage faster payer response times
4
Automation Implementation Plan
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Select PA automation platform compatible with your EHR
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Start with high-volume, standardized authorization types (imaging, DME, referrals)
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Set measurable goals: touchless rate, time saved per submission, denial reduction
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Train staff on the new workflow and escalation procedures
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Track weekly results and expand to complex authorization types