CMS 72-Hour Prior Authorization Rule Exposes Payment Cycle Delays in Healthcare Billing

The CMS rule requiring 72-hour prior authorization decisions for urgent requests is creating operational friction by accelerating approvals without corresponding improvements in billing and payment cycles. Health plans and providers now face misaligned timelines where clinical decisions move faster than claims processing and reimbursement. The policy change, which took effect for most payers in 2024, highlights gaps in interoperability and revenue cycle infrastructure. Managed care organizations are experiencing the downstream effects as prior authorization reform outpaces backend payment modernization.

Managed Care