Reducing Harmful Delays in Patient Care: Renewed Legislative Action on Prior Authorization

Prior authorization remains one of the most pressing—and frustrating—issues in healthcare today. It’s a constant pain point for providers, a barrier to timely care for patients, and a growing concern for lawmakers. The fact that the Reducing Medically Unnecessary Delays in Care Act has been reintroduced in 2025 is proof that the debate is far from over. This bipartisan effort signals renewed momentum to bring clinical oversight and common sense back into the prior auth process. Here’s what the bill proposes—and why it matters.

What’s in the Bill?

U.S. Representative Mark Green, MD (R-TN), has reintroduced the Reducing Medically Unnecessary Delays in Care Act of 2025. The legislation seeks to overhaul how prior authorization decisions are made by ensuring physician oversight in determining medical necessity.

Key provisions include:

• Mandating clinical criteria: Medicare, Medicare Advantage, and Medicare Part D plans must base prior authorization decisions on written clinical guidelines developed with input from board-certified physicians actively practicing in relevant specialties.
• Curbing non-clinical decision-making: The bill aims to limit the influence of non-clinical personnel in the authorization process.

This legislation is supported by several major medical organizations, including the AMA, AOA, and the American College of Emergency Physicians.

The Data Behind the Debate

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The push for reform is grounded in alarming data. According to a 2024 AMA survey:

• 23% of physicians said prior authorization caused a patient to be hospitalized
• 18% reported it led to a life-threatening event
• 94% agreed it negatively impacts patient care

These statistics are even more concerning in fields like pathology and laboratory testing, where 1 in 5 in-network claims are affected by prior auth denials—potentially delaying critical diagnostics and treatment.

As Rep. Green said, “Burdensome regulations are not only inconvenient, but life-threatening.”

What’s Next?

On June 25, I’ll be joined by three other experts in revenue cycle and prior authorization for a Dark Daily webinar, Changing the Narrative on Prior Authorization: A Collaborative, Programmatic Approach. I hope you’ll be able to join us as we walk through real-world case studies, discuss how integrating prior authorization strategies into the broader revenue cycle management process can enhance reimbursement and operational efficiency, and review recommended best practices.

📅 Register Here for the June 25 Webinar: Changing the Narrative on Prior Authorization: A Collaborative, Programmatic Approach