Prior auth got a federal clock in 2026. Practices say it got slower.

Prior authorization decisions came under a federal clock on Jan. 1. Eight months in, 44 percent of medical group leaders say the process is slower than it was in 2025, and just 7 percent say it is faster.

The numbers come from a Sept. 1 MGMA Stat poll of 178 medical group leaders. Another 40 percent said turnaround is about the same as last year, and 9 percent were unsure.

The requirement they were measuring against took effect at the start of the year under CMS-0057-F. Medicare Advantage organizations and several Medicaid and CHIP payers generally must return decisions on non-drug items and services within 72 hours for expedited requests and seven calendar days for standard requests. Payers also must give a specific reason when they deny.

The clock covers the smallest part of the job

Practices reporting slower turnaround told MGMA the holdups were status checks, peer-to-peer reviews and heavier documentation demands. None of those sit inside the decision window the rule regulates.

That is the gap. Before a payer's review period starts, staff have to determine whether an authorization is required at all, find the right submission channel and assemble supporting documentation. After the decision lands, they field requests for more information, denials and appeals. A shorter deadline on the middle step does not shrink the work on either side of it.

The trend line was already pointed the wrong way. MGMA's 2026 Regulatory Burden Report found 90 percent of practices saying prior authorization burden had grown over the previous 12 months, with Medicare Advantage ranked the most burdensome payer type to get an authorization through.

The staff cost shows up in the same places every time. A March poll found 61 percent of practices had staff logging into seven or more payer portals a week, with eligibility and prior authorization among the main reasons.

Two kinds of faster

The small group reporting improvement did not all get there the same way. Some pointed to payer moves: fewer services requiring authorization, broader electronic submission, gold carding. Others had bought the improvement themselves by adding an authorization specialist, redesigning workflows or buying new technology.

That distinction matters at budget time. The second kind gets patients an answer sooner while the practice absorbs the cost, which is a service win and an operating loss.

Build the baseline now

Practices that cannot say which payers are getting worse are in a weak position to argue about it. At minimum, track payer and plan, submission and decision dates, whether the request was standard or expedited, requests for additional information, status checks, peer-to-peer reviews, denials, appeals and the final resolution date.

CMS now requires affected payers to publicly report aggregate prior authorization metrics each year, including approval and denial rates, approvals after appeal and the average time between submission and decision. Practice-level data is what lets a leader check that reporting against what the front office actually experienced.

The next federal date is Jan. 1, 2027, when affected payers must stand up Prior Authorization APIs meant to move requests, decisions and documentation electronically. MGMA has published a readiness resource on the payer API technical requirements, and the Physicians Practice prior authorization handbook walks through what the rule does and does not require of payers, what to ask a vendor and what to put in a contract before the deadline.

The APIs will take some of the manual work out of submission. Nothing in them requires a payer to ask for less documentation, skip the peer-to-peer or stop sending a request back for more information, which is where this year's poll says the time is actually going.