- October 24, 2025
- Posted by: Josh Knoll
- Category: Prior Authorization
The healthcare industry has always been about helping patients get the right care at the right time. But if you’ve been practicing medicine for even a short while, you already know there’s one thing that stands in the way of that goal — prior authorization.
For years, physicians have raised their concerns about the delays, denials, and frustrations caused by prior authorization. A recent survey shows how serious this issue still is — and why it’s time to rethink how practices handle it.
According to the data, nearly 93% of physicians said that the prior authorization process negatively affects patient outcomes. About 94% said it delays access to care. Almost a quarter of physicians reported that it has even led to adverse events for patients. These numbers are hard to ignore. They show that the system, as it stands today, is deeply flawed.
Now, with the Centers for Medicare & Medicaid Services (CMS) launching a new model called the Wasteful and Inappropriate Service Reduction (WISeR) Model, things might soon change — but you need to be ready for it.
Let’s explore about the current happenings in the realm of prior authorization services, especially when WISeR model is concerned.
Understanding WISeR model in prior authorization services:
No wonder that the main objective of WISeR Model introduced by CMS is to make healthcare safer, most cost-effective and less wasteful for your patients with Original Medicare. It requires you to avoid low-value or unnecessary services so that your patients can also avoid unwanted spending. This particular model will review and process PA requests faster by leveraging advanced technology and AI model. You might have already realized that there are overused procedures like skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for osteoarthritis, and the WISeR model is going to target such procedures.
The WISeR Model also aims to stop fraud, waste, and abuse in Medicare. This is important because unnecessary or low-value services not only waste money but also put patients at risk.
Related Reading: Are you making these common mistakes in Prior Authorization?
The Reality of Prior Authorization Delays
The shocking fact is that 25% of the total U.S healthcare expenditure went in vain as Medicare spent almost $5.8 billion on services that added little to no value. It shows how severe the problem really is. It is true that cutting waste is important, but that doesn’t mean patients should compromise with the care they need.
The goal here is pretty straightforward- to ensure your patients always get exactly what they require. You may face delays, denials, and frequent issues related to this if you are not prepared. The truth is that prior authorization still feels like a never-ending battle as PA requests take time, any single delay frustrates your patients and each denial hits your practice’s bottom line.
Challenges in Managing Prior Authorization:
For most healthcare practices, prior authorization feels like a constant struggle. Every request takes time, any single delay upsets patients, and denials hurt revenue. Most doctors consider prior authorization as the real barrier to patient care and numbers always prove that. Almost 24% of physicians admit that prior authorization causes harm to the patients and for 87%, it wastes resources and 27% physicians feel frustrated with its intricate nature. Doing prior authorization in-house may seem doable, but it quickly becomes exhausting. Each insurer has different rules, and even a small mistake — like a missing code or wrong form — can cause rejection. Your staff members spend hours on calls, resubmitting denied requests and handling paperwork instead of focusing on patient care. The whole process always slows everything down, increases costs and leads to administrative burnout. It also affects trust, as patients get frustrated when care is delayed. That’s why more and more practices now rely on professional prior authorization services to simplify the process, reduce denials, and keep their focus where it belongs — on patient care.
The future of prior authorization is moving toward automation, accuracy, and compliance, and the WISeR Model shows this clearly. Professional prior authorization services are already designed for this change. They use trained experts, smart workflows, and advanced ePA tools to make the process faster and smoother, just like the new CMS prior authorization approach. These services can help your practice stay ready and adapt easily to what’s coming next.
How Professional Prior Authorization Companies Help:
1. Faster Turnaround Times
It is really possible to enjoy faster PA approvals with experts managing your end-to-end PA process. Experts in a professional company know about all the payers need, the documentation process, and how to avoid unnecessary back-and-forth.
2. Reduced Denials and Errors
Professional prior authorization teams are trained to handle payer-specific requirements. They minimize errors, prevent missing data, and reduce denial rates.
3. Improved Patient Satisfaction
Patients are always happier when they get their treatments approved fast. Always remember that your patients never appreciate the longer waiting time for a procedure and sudden cancellations.
4. Better Use of Staff Time
Your team can work more efficiently without being bogged down with the paperwork when you work with a professional prior authorization service provider.
5. Compliance and Documentation Support
You cannot deny the fact that compliance is more important than ever with CMS tightening oversight. A professional company always ensures that your documentation aligns with payer and federal guidelines, reducing audit risks.
The WISeR Model may not affect everyone right away, but it shows where healthcare is headed. Providers will need to use technology more, follow stricter rules, and use resources efficiently. Professional prior authorization services are not just helpful — they are essential. They keep your practice compliant, speed up approvals, and protect your revenue, no matter how many new regulations appear.
Are you already looking forward to hiring a perfect prior authorization services company? SunKnowledge is here to help you!
Related Reading: How to Overcome Insurance Denials in Prior Authorization
SunKnowledge: Your Reliable Partner in Prior Authorization Services
We have helped physician practices tackle prior authorization challenges for more than a decade. Our solution combines workflow automation, payer knowledge, and clinician-friendly documentation. We identify necessary documents, connect with major payers, and submit and track requests for seamless authorizations. With same-day submissions, constant follow-ups, and robust templates for specialty meds, advanced imaging, or DME, we speed approvals and reduce errors. We are currently the only RCM-specialist that works for both payers and providers, thus always enabling our clients to always stay on top of all the billing rules and guidelines. We also provide clinical data support and customized reporting, helping practices cut denials, improve patient access, and reduce administrative work. If prior authorization is a struggle, our experts are here to help. Hire us as your next-door prior authorization solution at just $7/hour and enjoy a seamless PA process all the time. Outsource your prior authorization services today.