Navigating Prior Authorization in 2025: Tactics to Fight Back and Win!

Originally focused on the costliest types of care, Payors now commonly require Prior Authorization for many mundane medical encounters, including basic imaging and prescription refills. Thus, prior authorization is no longer used as a method to limit the wasteful use of resources but rather may be used as a tool that prevents patients from getting the vital care they need.

The Centers for Medicare & Medicaid Services (CMS) recently introduced the Interoperability and Prior Authorization Final Rule, aimed at simplifying the Prior Authorization (PA) process for Payors. While PA serves an important role in ensuring medical care is necessary and appropriate, many healthcare providers have expressed frustration with its current state. Complex and inconsistent Payor requirements often result in long delays, creating barriers to timely patient care.

Starting in 2026, this new rule will require Payors to provide faster decisions: within 72 hours for urgent (expedited) requests and seven calendar days for standard (non-urgent) requests. These changes promise to significantly improve response times and reduce administrative hurdles.

However, providers don’t have to wait until 2026 to make improvements. There are practical strategies available today that can help ease the burden of Prior Authorization while ensuring patients receive the care they need without unnecessary delays.

Join this comprehensive webinar by healthcare attorney Osato F. Chitou, Esq., MPH to explore actionable steps healthcare providers can take now to navigate the complexities of Prior Authorization and streamline their operational processes. Learn best practices, improve workflows, and prepare for the implementation of the CMS Final Rule.

Webinar Objectives

The primary objective of the webinar is to help providers and practices minimize the delays and negative impacts of Prior Authorization by implementing efficient operations and best practices, ultimately improving patient outcomes and reducing administrative strain.

Webinar Agenda

• Overview of the CMS Final Rule, new regulations and their implications for providers.
• Current Challenges of Prior Authorization
• Tools and strategies to reduce the administrative burden and simplify pre-authorization process
• Review of the pros and cons of various submission methods for Prior Authorization
• How to effectively handle and appeal denied requests.
• Preparing for the new CMS requirements.

Webinar Highlights

• Understand CMS Final Rule and what it means for Providers
• Understand ways to reduce the prior authorization burden
• Understand practice operations that can make your prior authorization process more efficient
• Understand the advantages and disadvantages of the myriad Prior Authorization submission methods
• Understand the procedures and medications that likely to trigger prior-authorization requirements 
• Understand how to respond to an inappropriately denied prior authorization

Who Should Attend

• Medical Directors
• Practice Administrators
• Prior Authorization Specialists
• Medical Assistant
• Medical Coder
• Provider Groups
• Management Service Organizations (MSOs)