Radiology’s Fight Against Prior Authorization Delays

Deepti Verma, BS, third-year medical student at Penn State College of Medicine, contributed this article.

Prior authorization, originally introduced to ensure medical resources were used appropriately and cost-effectively, has grown into one of the most significant hindrances to timely imaging and efficient patient care. Physicians nationwide continue to face delays in imaging that slow down diagnoses, add unnecessary administrative steps and reduce the efficiency of patient care delivery.

In outpatient settings, prior authorization most often delays nonemergent yet clinically important studies such as MRIs for musculoskeletal injuries, follow-up imaging on cancer surveillance and CT scans ordered to evaluate chronic abdominal pain. While these may not be immediately life-threatening prognoses, imaging delays can delay diagnoses, prolong symptoms and delay initiation or adjustment of treatment plans. For radiologists, these disruptions can translate into cancelled appointments, administrative fatigue and ultimately significant barriers to an efficient workflow.

Current prior authorization requirements necessitate physicians to seek insurer approval for imaging studies that are clearly justified by clinical presentation. A 2024 American Medical Association survey found that physicians spend more than 13 hours each week navigating prior authorization tasks, time deterred from direct patient care, teaching and other responsibilities that sustain the healthcare system. Because advanced imaging often requires pre-approval, radiology is disproportionately affected by prior authorization delays. When approvals stall, critical studies may be postponed, turning what could have been an early detection into a late diagnosis and possibly a missed window for timely treatment.

ACR^® continues to lead national efforts to make prior authorization more efficient and clinically appropriate. Evidence-based ACR Appropriateness Criteria^® are developed and reviewed by expert panels and present the foundation of clinical decision support systems as well as an alternative to prior authorization. As noted in this ACR Bulletin article by the ACR Commission on Economics Chair, the Radiology Outpatient Ordering Transmission (ROOT) Act would amend the Protecting Access to Medicare Act (PAMA) of 2014 by “replacing the problematic ‘real-time’ claims processing requirement with a provider attestation of qualified appropriate-use-criteria consultation.”

Through ACR advocacy initiatives, the College works with lawmakers and insurers to reduce the administrative burden while supporting national legislation. Another such example is ACR support of the Improving Seniors’ Timely Access to Care Act, which aims to streamline prior authorization by requiring electronic submissions and well-defined response timelines for Medicare Advantage plans. This act also encourages real-time approvals for routine requests and public reporting of insurer data, core features that can appreciably shorten patient wait times.

ACR also partners with state chapters through the Radiology Advocacy Network (RAN), which assembles radiologists, residents and students to drive practical and patient-centered policy change at the local level. For example, RAN’s monthly Action Alerts share opportunities to contact congressional representatives about pending reforms. These continual call-to-actions create the impetus needed to mold national policy and keep imaging access at the focus of clinical care.

While many typical policy battles occur in committee rooms, the groundwork for advocacy originates much earlier in medical training. For medical students and residents, watching how prior authorization impacts their teams, from delayed imaging approvals to disrupted workflows, provides an early look at how administrative hurdles can influence patient care. This early exposure is more than logistics — it disrupts teaching opportunities, diagnostic learning and overall patient care outcomes.

Recognizing this connection is the first step toward meaningful participation in advocacy. Medical students can start by joining the Pre-Radiology Advocacy Network (Pre-RAN), an MSS initiative that connects students with advocacy opportunities through webinars and events like Hill Day at the ACR Annual Meeting, where they can communicate with legislators, analyze health policy and represent radiology’s interests. By engaging early, medical students gain practical awareness into healthcare policy and its relationship with clinical medicine.

Ultimately, this issue is not about paperwork — it’s about our patients. Every unnecessary delay in imaging is a delay in diagnosis. Every denied authorization can lead to repeat visits, redundant tests and increased anxiety. Radiologists are particularly positioned to advocate for a system that prioritizes clinical judgment over administrative gatekeeping. Advocacy is not only reserved for policymakers — it’s a professional responsibility that begins with awareness and action. Together, we can transform the prior authorization issue from a source of frustration into a spark for reform, one that reorients care around patients, where it belongs.