The 72-Hour Hurdle: Faster Prior Authorization is Exposing Healthcare’s Broken Billing Cycle

Faster approvals for care through prior authorization lose much of their meaning when the payments experience that follows remains slow and unpredictable.

With the CMS Interoperability & Prior Authorization Rule now in effect, payers and provider systems are being pushed to rethink how care decisions are made, including shortening decision timelines, increasing transparency around denials, and taking meaningful steps toward reducing administrative burden across the healthcare system. 

Electronic prior authorization and defined response timelines have compressed approval cycles that once took weeks into days, and for expedited cases, decisions are required within 72 hours. For a healthcare ecosystem weighed down by manual processes or administrative backlogs, this change represents an exciting moment of progress. 

In many ways, this new rule will significantly move the industry forward by reducing delays, increasing transparency, and accelerating access to care. While these requirements formally apply only to CMS programs like Medicare and Medicaid, they are landing in an ecosystem where many payers and providers have already modernized their platforms and workflows across the business. As a result, the rule is surfacing a broader, industry‑wide challenge: decision velocity has increased, but the payments experience that follows remains slow and fragmented.

Approvals are moving faster, but billing, claims, and payments often still move at the pace of a much older system. Think of it like a firehose with a kinked line, where the city has installed a high-pressure pump that can move thousands of gallons of water per minute to fight a fire, but the water never reaches the flames with enough force because the delivery hose is full of knots and narrow segments that throttle the flow to a trickle. 

The healthcare ecosystem is fixing how quickly decisions get made, without fixing how quickly money actually moves. This isn’t a failure of reform. It’s evidence that reform is working — and revealing where modernization needs to continue. 

The billing cycle is now the slowest link 

Once a decision is made and an authorization is granted, a different journey begins that remains far less streamlined. 

Authorization data frequently lives in one system, while billing, claims submission, reconciliation, and payments live in others. As information flows downstream, the details that were already captured upstream often have to be re-entered, re-verified, or manually reconciled across disconnected workflows. These handoffs slow the process and introduce friction at every step, like water being forced through disconnected hose segments that leak pressure at every joint. 

For clinical staff, this means more rework and operational strain, leaving teams that are already stretched thin to spend time resolving discrepancies. For finance teams, this friction translates into delayed or incomplete claims submissions, more time spent in accounts receivable, and a slower time to cash — even when care was authorized quickly. 

The impact can be especially frustrating for patients as they encounter confusing bills, delayed statements, or unexpected financial obligations weeks later, even though care was approved quickly within the required window. 

A 72‑hour decision window loses its full impact when the billing and payment cycle that follows still stretches on for weeks, and sometimes even longer. The faster pace of prior authorization hasn’t created these challenges, but it has put a spotlight on the need to modernize billing and payments, too. 

From faster decisions to faster dollars 

Prior authorization reform assumes that downstream systems can keep up with faster decisions. In reality, financial systems haven’t yet been modernized to match the faster environment that authorization reform has created, leaving the system with a high-capacity pump but an outdated delivery line. 

The good news is that the next phase of progress doesn’t require rethinking authorization again. Instead, it requires ensuring that authorization data flows cleanly and automatically into billing and payment workflows, without being re‑entered or re‑interpreted at every step. 

In practice, this means moving towards solutions like straight‑through processing: an automated, end‑to‑end approach that allows work to move through the revenue cycle without manual handoffs or rework. When authorization data is captured once, structured correctly, and shared across systems, it can automatically trigger billing, claims submission, and payment workflows. The result is a more continuous financial process that keeps pace with faster clinical decisions and rising patient expectations. In effect, this removes the kinks in the hose, allowing data to flow continuously from authorization to payment without losing force along the way.

The benefits compound when financial processes are aligned with faster approvals. Organizations see reduced administrative burden, fewer denials and rework cycles, improved staff experience, and faster access to revenue. Just as importantly, patients benefit from clearer, more predictable financial experiences that reinforce trust at a moment when clarity matters more than ever.

Faster decisions are powerful, but only when the systems that follow are built to move at the same pace. 

The next phase of healthcare modernization 

Prior authorization reform should be viewed as a catalyst, not a conclusion. 

Health systems have already significantly invested in modernizing how approvals are requested and processed. The next logical step is to extend that same modernization mindset across the rest of the financial lifecycle, from authorization through payment. 

This next phase is about aligning financial operations with the realities of modern care, rather than just layering technology across a fragmented environment. When approvals happen in days, the systems responsible for billing and payment can’t operate in an old environment that takes weeks to progress. 

Healthcare systems that fully capitalize on faster prior authorization will be those that recognize this moment as an opportunity to keep the momentum going. By addressing the financial workflows that trail behind faster decisions, they can reduce friction, strengthen sustainability, and deliver a more coherent experience for patients and staff alike. 

Faster approvals are now a reality. The next challenge — and the next opportunity — is making sure the money can keep up.

Photo: pick-uppath, Getty Images

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